Automated Intraoperative Short Messaging Service Updates: Quality Improvement Initiative to Relieve Caregivers’ Worries (Preprint)

Abstract

BACKGROUND Undergoing a surgical procedure is anxiety provoking for patients and their caregivers. During the intra-operative period, caregivers seek out informational updates from healthcare professionals, a situation complicated by COVID-19 health measures that require caregivers to wait outside the hospital. SMS-based communication that allows caregivers to follow their loved ones through surgery has shown promise in relieving anxiety and improving satisfaction with overall care. This form of communication is also well accepted by healthcare professionals and may be effective at relieving staff burden. OBJECTIVE Here we describe a quality improvement initiative of a standardized and integrated intra-operative SMS-based system to improve communication between surgical teams and caregivers. The main goal was to reduce caregiver anxiety; secondary goals included improving satisfaction with care and not increasing staff burden. METHODS A large tertiary care hospital offered the SMS service to caregivers who were waiting for loved ones undergoing surgery. SMS messages were integrated into the clinical information system software and sent at key points during the surgical journey to phone numbers provided by caregivers. A satisfaction survey was sent to caregivers one business day after surgery. Data were collected between Feb 16th and July 14th 2021. RESULTS Of the 8,129 surgeries scheduled, caregivers waiting for 6,149 surgeries (76%) agreed to receive SMS messages. A total of 34,129 messages were sent. The satisfaction survey was completed by 2,088/6,149 or 34 % of caregivers. Satisfaction with messages was high, with the majority of respondents reporting the messages received were adequate (71%), clear (74%), informative (72%) and met their needs (60%). Receiving text messages reduced caregiver anxiety (score 8.5 out of 10) and the overall satisfaction score was high (4.5 out of 5). Technical errors were reported by 111 caregivers. Suggestions for improvements included having messages sent more often, providing greater patient detail and being offered in other languages. CONCLUSIONS This digital health initiative provided SMS messages that were standardized and systematically sent to caregivers waiting for their loved ones undergoing surgery. This in turn decreased caregiver anxiety, with no additional burden to staff. In creating digital healthcare innovations, what patients and their families find useful and appreciated will ultimately determine uptake. Thus, caregiver feedback will inform future iterations of this initiative.