Emergency department discharge instructions sent by text message.

OBJECTIVES

Discharged Emergency Department (ED) patients should receive instructions about their condition, including self-care and return-to-care guidance, while satisfying medicolegal requirements. Verbal instructions are forgotten or poorly understood. Written instructions are best practice, but usage barriers include multifactorial inefficiencies getting them to the patient and patient challenges finding them later when needed. In this feasibility and uptake study, we sought to address these barriers by developing a website that enables physicians to send condition-specific discharge instructions by text message.

METHODS

We recruited from the approximately 60 physicians working in the Saskatoon, Canada adult EDs, which serve > 140,000 patients/year. The physician visits our website, enters the patient's phone number, selects a condition, and taps "send." The patient receives a text message with a link to condition-specific discharge instructions. We analyzed link access data and surveyed physician feedback.

RESULTS

Over a 2-month study period, 115 discharge instructions were texted (< 1% of an estimated maximum 17,000 discharges). 83% were accessed, 43% repeatedly. Links were visited quickly: 57% within one minute, 81% within one hour, and 97% within 24 h. 36 conditions were selected, most commonly concussion (19%), abdominal pain (9%), laceration (7%), and renal colic (7%). Seventeen physicians (28%) responded to our survey. 47% indicated they do not typically provide written (paper-based) discharge instructions. 87% ranked our system ≥ 8/10 in ease of use (0 = very difficult, 10 = very easy), 73% ranked it ≥ 7/10 in efficiency compared to usual practice (0 = maximally inefficient, 10 = maximally efficient). 93% said they would use our system going forward.

CONCLUSIONS

Our study is limited by low physician uptake. However, positive physician feedback and quick and repeated patient access to instructions together suggest our approach might be a feasible way to improve ED discharge practice.