Telephoned, Texted, or Typed Out: A Randomized Trial of Physician–Patient Communication After Emergency Department Discharge

Publication date: Available online 1 September 2018

Source: The Journal of Emergency Medicine

Author(s): Jessica A. Shuen, Michael P. Wilson, Allyson Kreshak, Samuel Mullinax, Jesse Brennan, Edward M. Castillo, Corinne Hinkle, Gary M. Vilke

Abstract

Background

Novel means of emergency department (ED) post-discharge communication—telephone callbacks and text messages—are increasingly being utilized to facilitate patient-oriented outcomes, such as ED revisits, patient adherence, and satisfaction.

Objective

The primary measure of interest is the rate of ED revisits in the week after discharge. The secondary measures of interests are rate of primary medical doctor (PMD) or specialist physician contact in the week after discharge and patient satisfaction.

Methods

Pilot randomized controlled trial with three groups: usual discharge; usual care + phone call 48 h after discharge asking if patients wanted to speak with a physician; or usual care + text message 48 h after discharge asking if patients wanted to speak with a physician. All participants received a 1-week assessment of patient satisfaction. ED revisit and contact with PMD or specialist physician within 7 days of discharge were obtained from electronic medical record and analyzed using χ² test.

Results

Two hundred and fifty-one patients were enrolled and randomized (66 control, 103 phone, 82 text). Although the three groups did not show a statistically significant difference, the phone and text groups had similar and lower proportions of patients revisiting the ED (>50% reduction) and calling or visiting their PMD or specialist physician (approximately 30% reduction) than the control group (χ² = 4.57, degrees of freedom [df] = 2, p = 0.10; χ² = 1.36, df = 2, p = 0.51). There was no difference in patient satisfaction (χ² = 2.88, df = 2, p = 0.24).

Conclusions

Patients who are contacted for ED follow-up by phone and text, though perhaps not more satisfied, may tend to revisit the ED and contact their PMD or specialty physician less often than patients receiving standard written discharge instructions. However, this pilot study is underpowered, so larger randomized studies are needed to confirm.

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