Does Receiving a Text Message Reminder Increase Follow-up Compliance After Discharge From a Pediatric Emergency Department?

Abstract

Objectives: Compliance with recommended follow-up from the pediatric emergency department (PED) has been shown to be poor. This study evaluated whether a text message reminder to the caregivers after discharge from the PED improved compliance with recommended primary care follow-up.Methods: This was a blinded randomized control trial conducted at a level 1 pediatric trauma center. The intervention was a text message sent to the caregiver within 24 hours of discharge from the PED reminding them to follow up with their primary care doctor. Patients were eligible if the caregiver had text message capability on their cellular phones, they were currently established patients of the organization's Pediatric Faculty Practice, they were discharged home from the PED, and they were referred for follow-up within 1 week of discharge by the pediatric emergency physician. After informed consent, pediatric patients were randomized to either an intervention group (text message appointment reminder) or a control group (standard scheduling with no reminder). The patient, treating physician, and primary care outpatient center were blinded to the group assignment. Enrollment occurred 24 hours per day and 7 days per week.Results: There were 123 patients enrolled in the study, 62 patients randomized to the control group (standard scheduling) and 61 randomized to the intervention group (text message appointment reminder). Of the patients, 58% were male and 42% were female, with the average age of the patients being 2.2 years (SD, 2.8). The majority of patients were seen in the PED on a weekday, with 24% presenting on a weekend. Only 28% of patients completed the recommended follow-up, and the average time from PED discharge to follow-up was 6 days (SD, 4.2; range, 0-17 days). There was no significant difference in follow-up in the standard treatment group (19/62, 31%) versus the text message intervention group (16/61, 26%) (P = 0.69; rate ratio, 0.94; 95% confidence interval, 0.75-1.18). When we assessed other variables, we found that parents of younger children were more likely to follow up as recommended by the pediatric ED physician. Of those who were compliant with follow-up, we found a mean age of 1.3 years (SD, 2.0; range, 0.8-9.1) versus 2.6 years (SD, 3.0; range, 0.08-15.3) for those who were not compliant with follow-up (P = 0.02). Conclusions:In this randomized controlled study, a text message reminder to caregivers did not improve compliance for PED patients. However, caregivers of younger children were more likely to complete follow-up as recommended by the PED physician compared with caregivers of older children.

Ambulatory follow‐up among publicly insured children discharged from the emergency department

“…For example, follow‐up appointments scheduled from the ED, 43 intensive asthma education, 44 and monetary incentives 45 may improve follow‐up among children discharged from the ED with asthma. Other studies have suggested that follow‐up phone calls and care coordination efforts may improve follow‐up 46,47 and reduce potentially unnecessary ED visits, 47,48 whereas text messaging and email communications may be of more limited value 49,50 …”

Improving Follow‐up Attendance for Discharged Emergency Care Patients Using Automated Phone System to Self‐schedule: A Randomized Controlled Trial

“…We found that an automated self‐scheduling text and phone messaging system improved follow‐up attendance at 30 and 120 days after discharge from the ED. Previous studies examining automated reminders to improve follow‐up adherence have mixed results 11–13 . A pediatric ED study using SMS appointment reminders found no improvement in follow‐up to primary care within 17 days of discharge 11 .…”

“…Previous studies examining automated reminders to improve follow‐up adherence have mixed results 11–13 . A pediatric ED study using SMS appointment reminders found no improvement in follow‐up to primary care within 17 days of discharge 11 . Another ED study focusing on patients with a specific diagnosis found that SMS appointment reminders improved follow‐up rates by 28.3% for urgent referral to primary care providers 13 .…”

“…Our intervention had more flexibility and capability than simple automated reminder systems previously published (Figure 1). 11–13 Self‐scheduling is one example of how automated phone systems can integrate design suggestions to improve appointment reminders that support patient self‐sufficiency to manage doctor appointments 9 …”

“…Using automated phone appointment reminders in the inpatient setting helped reduce no‐shows for follow‐up appointments by at least 29%, at an average cost savings of $0.88 per patient 8 . However, automated phone reminders in the ED have had mixed results 11–13 . We wanted to see if an inexpensive, automated appointment system with capabilities beyond a simple reminder could improve follow‐up referrals in the ED.…”