Multi-user Application - Updating All Clients When A User Updates Data (push Vs Pull)?

I am designing a fairly small application to manage a waiting area for a clinical department. There will be a receptionist who books appointments and updates exisiting appointments to say that a patient has "Arrived". In seperate rooms will be nurses who call patients who have "Arrived" and update the appointment as "In Session" and finally as "Discharged". The appointments are viewed in a flexgrid with nurses across the top and time down the left, patient names are displayed at the relevant times and the cells are shaded a colour to represent the current appointment status ("Booked", "Arrived", "In Session" and "Discharged").

I am using SQL Server as the back-end and Visual Basic 6 (I know) as my front-end.I have been told that there will be 2 or 3 nurses plus the receptionist logged in to the system but I would like to cater for growth.My question is what is the best mechanism to use in order to reflect the status change made by one user on the screens of the other users currently logged in?

I have been thinking about using a timer to refresh the data at a set interval but I do not want to keep hitting the server excessively (although what is considered excessive? we would be talking about a call for data every 60 secs per user). Plus the server could be serving data for many other applications so this is another consideration.Alternatively I have been thinking about sending some kind of message via Winsock to the other users notifying them of data changes as they happen. I don't have a lot of experience with this and am concerned about clients not receiving messages and users seeing old data. It also seems strange to me that once the days appointments have been retrieved from the database that "in theory" a client could go the whole day without having to query the database again to pick up changes - kind of scary.Some information on the data:We would probably be looking at around 100 appointments per day We capture patient name, date of birth, date and time of appointment and appointment status.What is the standard approach / best practice for this kind of scenario?