Efficiency of Text Message Contact on Medical Safety in Outpatient Surgery: Retrospective Study

Abstract

Background Establishing pre- and postoperative contact with patients is part of successful medical management in outpatient surgery. In France, this is mostly done via telephone. Automated information with short message service (SMS) reminders might be an interesting alternative to increase the rate of compliance with preoperative instructions, but no study has shown the safety of this approach. Objective The objective of this study was to evaluate the impact of pre- and postoperative automated information with SMS reminders on medical safety in outpatient surgery. Methods We conducted a retrospective, single-center, nonrandomized, controlled study with a before-after design. All adult patients who had outpatient surgery between September 2016 and December 2017 in our university hospital center were included. Before April 2017, patients were contacted by telephone by an outpatient surgery nurse. After April 2017, patients were contacted by SMS reminder. All patients were contacted the day before and the day after surgery. Patients contacted by SMS reminder were also contacted on day 7 after surgery. The primary end point was the conversion rate to full-time hospitalization. Secondary end points were hospitalization causes (anesthetic, surgical, organizational) and hospitalization costs. Results A total of 4388 patients were included, 2160 before and 2228 after the introduction of SMS reminders. The conversion rate to full-time hospitalization was 34/4388 (0.77%) with a difference between SMS group (8/2228, 0.36%) and telephone group (26/2160, 1.20%). The cost of SMS reminders was estimated as half that of telephone calls. Conclusions In this work, we report a decrease in the rate of conversion to full-time hospitalization with the use of pre- and postoperative SMS reminders. This new approach could represent a safe and cost-effective method in an outpatient surgery setting.

Incidence of Postoperative Pain at 7 Days After Day Surgery Reported Using a Text Messaging Platform: Retrospective Observational Study

“…In this retrospective study, the prevalence of pain on the day after day surgery (318/6099, 5.2%) was similar to that found in a previous study (7%) [ 17 ] but much lower than that reported in the majority of the older studies. In a review published in 2002, the incidence of acute postoperative pain was 45% and ranged from 6% to 95% in 13 studies that included mixed surgical procedures [ 8 ].…”

“…The emergency consultation or rehospitalization rate found in this study (679/6099, 11.1%) is higher than that reported in our previous work (6.7%) [17] but is comparable to that found by McIsaac et al in 2015 [24], wherein in their population-based cohort of 296,497 outpatients in Canada, 10.5% returned to the emergency unit or were readmitted to hospital within 30 days after the surgery. In another study [18], 2% of 744 patients were admitted to the hospital on an unplanned basis, returned to the hospital, or visited their general practitioner during the postoperative course, but the study was performed on 4 postoperative days only.…”

“…The process of the semi-intelligent platform of SMS text messaging has been previously described [ 17 ]. Messaging started 2 days before the surgery with an SMS text message reminder and the possibility of alerting the medical staff if the patient was unable to attend the surgery.…”

“…In a Dutch study conducted in 1490 surgical inpatients, 41% of the patients reported moderate or severe pain on the day of surgery, with a declining rate of 14% after 4 days [19]. Similarly, Peuchot et al [17] showed that the incidence of outpatients with pain at 7 days after the surgery was 2.60%. However, a recent study [8] showed that there are multiple distinct trajectories of acute postoperative pain intensity, with 63% of the hospitalized patients reporting high or moderate-to-highly stable and sustained pain in the first 7 days after the surgery.…”

“…In the intraoperative period, the emphasis is on strategies using infiltrations and peripheral blocks in addition to the multimodal analgesia strategy, including the use of nonsteroidal anti-inflammatory drugs [ 15 , 16 ]. In fact, a very recent study [ 17 ] on the latest technique of pain management in 2228 patients showed that only 7% of the patients rated their pain as more than 3/10 on the day after the surgery. However, studies have mainly focused on the early evaluation of pain (the first 3 or 4 days after the surgery) without always considering the occasional prolonged nature of this pain [ 18 ].…”