ArticleBMC nursing2026
Digital alert fatigue and escalation behaviours in nurse-led remote postoperative care: a cross-sectional study.
Article in BMC nursing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
backgroundNurse-led remote postoperative care has been increasingly adopted to enhance continuity of care following hospital discharge. However, the high volume of digital information and alerts generated during remote care may place substantial cognitive demands on nurses, potentially resulting in digital alert fatigue. To date, limited research has explored the association between digital alert fatigue and nurses’ risk escalation behaviours in remote postoperative care settings.
methodsThis descriptive cross-sectional study surveyed registered nurses involved in nurse-led remote postoperative care at a tertiary hospital. Data were collected using a structured electronic questionnaire assessing demographic and work-related characteristics, digital alert fatigue, and escalation behaviours. Digital alert fatigue and escalation behaviours were measured using context-specific, validated self-report scales. Descriptive statistics were used to summarise participant characteristics and key study variables. Correlation analyses and multivariable linear regression models were performed to examine the association between digital alert fatigue and escalation behaviours, adjusting for nursing experience, workload-related factors, and the availability of standardised escalation protocols.
resultsA total of 103 nurses were included in the final analysis. Nurses reported moderate to moderately high levels of digital alert fatigue (Median 3.4; IQR: 3.0–3.8) and moderate levels of escalation behaviours (Median 3.6; IQR: 3.2–4.0). Correlation analysis revealed a significant negative association between digital alert fatigue and escalation behaviours (r = − 0.41, p < 0.001). In multivariable linear regression analyses, higher digital alert fatigue remained significantly associated with lower escalation behaviour scores after adjustment for nursing experience, workload, and the availability of standardised escalation protocols (β= −0.35, p < 0.001). In addition, nurses with access to standardised escalation protocols reported significantly higher escalation behaviour scores (β = 0.27, p = 0.003). By contrast, higher digital workload indicators demonstrated directionally consistent but relatively weaker negative associations with escalation behaviours.
conclusionsDigital alert fatigue is common in nurse-led remote postoperative care and is associated with reduced proactive escalation behaviours among nurses. These findings suggest that optimizing digital alert management strategies and implementing standardised escalation pathways may support nurses’ clinical decision-making and enhance patient safety in remote care settings. CLINICAL TRIAL NUMBER: Not applicable.
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