Background: Radiation therapists (RTTs) administer radiation treatments to patients with cancer. Treatments are delivered using linear accelerators (LINACs), operated by vendor specific software. Prior to delivering treatment, RTTs perform a time-out, and read aloud critical electronic communications (alerts) entered by members of the radiation oncology care team. Alerts are effective at communicating critical information, including treatment setup and imaging instructions, but can become a source of error due to alert fatigue when placed indiscriminately. Methods: A multicenter retrospective review of alert use per patient was conducted in 4 radiation oncology centers with a total of 6 LINACs. Alert usage was reviewed pre-intervention for 40 randomly selected patients using manual chart review. Each alert was reviewed for frequency and utilization. In attempt of improving communication and reducing alert fatigue, a multidisciplinary process improvement working group (with Radiation Oncologists, RTTs, nursing, physicists, and administration) was formed to review the utilization of alerts in our department and propose interventions. Three months after intervention, an additional 40 chart review was performed. Our aim was to reduce the volume of alerts by 20% within 3 months. A 2-tail t-test was used for statistical analysis. Results: Process improvements were implemented to reduce the volume of alerts per patient. Interventions included 1) defining an alert for all departmental staff, 2) creating guidelines for appropriate utilization of alerts, 3) routing communications not critical to RTTs at the time of radiation treatment administration through other channels, and 4) training staff as to the above. The pre-intervention review yielded 239 alerts. Post-intervention, there were 173 alerts, a reduction of 27% (p =.008). Conclusions: This practice change reduced average alert volume by 27%. As a result, alerts which are critical to safe treatment delivery by RTTs (i.e. daily setup alerts), became more heavily represented. Other alerts, which could be communicated effectively in other ways (i.e. OTVs [weekly on treatment visit with Radiation Oncologist]), were eliminated. By decreasing alert volume, the risk of RTT alert fatigue is reduced, communication improved, and treatment safety enhanced.