Bi-directional Texting For Better Outcomes: Enhancing Patient Safety And Satisfaction Beyond Hospital Walls

• By: FELIPPI, Rafael (Department of Physicians’ Alliance for Quality, United States)
• Co-author(s): Mr Rafael Felippi (Department of Physicians’ Alliance for Quality, Houston Methodist, Houston, United States)
  
• Abstract:

  Title:
  Bi-Directional Texting for Better Outcomes: Enhancing Patient Safety and Satisfaction Beyond Hospital Walls
  
  Authors:
  Dr. Rafael Felippi, Jenny Hickman, Theresa Pinn-Kirkland
  
  Affiliation:
  Department of Physicians’ Alliance for Quality, Houston Methodist, Texas, United States
  
  Introduction
  Approximately 20% of discharged patients experience adverse events, leading to avoidable healthcare utilization. Care transition breakdowns contribute to confusion, medication errors, dissatisfaction, and poorer health outcomes. In response to these challenges, Houston Methodist (HM) implemented a post-discharge outreach bi-directional texting program facilitated by HM nurses, clinical pharmacists, and coordinators.
  
  Purpose
  To evaluate the program’s impact on reducing 30-day hospital utilization, including emergency department (ED) visits and readmissions, and improving patient satisfaction.
  
  Method
  This retrospective observational cohort study was conducted using data from 2023, which comprised of 163,738 outreaches, predominantly through text messages (97%) and automated phone calls (3%). The study analyzed response rates, engagement levels (defined as three or more incoming text messages), and alert domains, focusing on discharge education, medication management, follow-up care, and health condition queries. Hospital utilization rates and patient satisfaction, measured using Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, were compared between participants and non-participants.
  
  Results
  Among the outreached patients, there was a notable 62.8% response rate, with 41.9% actively engaging with the program. The most prevalent alert domains included inquiries about discharge education (38.2%), medication-related concerns (33.3%), follow-up care (16.2%), and health conditions (12.3%). Within the medication-related alerts, the request for medication clarifications (56%) and assistance with prescription issues (12.3%) were most common. Engaged participants demonstrated a significantly lower 30-day hospital utilization rate (ED visits and readmissions) of 18.6% compared to 22.6% among non-participants. Moreover, participants exhibited a reduced 30-day unplanned readmission rate of 7.0% compared to 9.1% for non-participants. Notably, patient satisfaction scores, particularly in the "Overall Rating of Hospital" domain, improved significantly, with participants rating at 83.6% compared to 80.3% for non-participants.
  
  Conclusion
  The findings underscore the effectiveness of the automated texting program in reducing 30-day hospital utilization rates and enhancing patient satisfaction following discharge. The program not only addressed patients’ immediate concerns but also amassed granular, actionable data for ongoing process improvement and enhanced patient safety measures. These results emphasize the importance of innovative approaches in optimizing care coordination and improving post-discharge outcomes.