By Melinda Young
EXECUTIVE SUMMARY
A post-discharge texting program that uses well-trained care coordinators to follow up on patients’ concerns achieved positive outcomes, including fewer readmissions and more satisfied and engaged patients.
- The key to patients’ satisfaction with the program was phone calls to answer their questions.
- Automated texts were sent to patients soon after hospital discharge. Patients could respond if they had any questions or concerns.
- A member of a team of coordinators, including case management, nursing, and pharmacy, would call the patient to address concerns and make referrals as needed.
Technology can help case management and care coordination programs achieve greater efficiency and consistency in helping patients transition from the hospital to home. But if follow-up outreach is entirely automated, it may lack something very important to patients and their experience.
The results of a recent study revealed that a post-discharge texting program can greatly reduce readmissions and revisits. But there was a surprising finding: It can make patients happy or satisfied, as indicated by patient feedback on the program. The key to its success is well-trained, motivated, caring coordinators who connect with patients directly when they have post-discharge concerns and questions.1,2
“We wanted a way to reach patients after they leave the hospital for any questions they might have where they could get a quick answer,” says Courtenay Bruce, JD, MA, CPHQ, lead study author and an associate chief experience officer at Houston Methodist.
For example, patients might want to know whether they can take ibuprofen along with their prescription medication. “We didn’t want them to wait for an appointment. While they have a follow-up appointment after leaving the hospital, it can be several days,” Bruce explains. “We wanted them to get answers in a timely manner at their convenience, and the method we used was texting.”
The care coordination program sent all discharged patients an automated text message, saying, “It’s Houston Methodist. We’re part of a post-discharge care team, and we just want to see if you have any questions or concerns.” “If they say ‘yes,’ our team calls them in a short time frame,” Bruce adds.
Most of the time, these calls are completed quickly, with the care coordinator giving patients an immediate answer to their concerns or questions. “We find that sense of convenience and accessibility really helps us in patient experience. It also promotes safety and positive outcomes because many times, the reason patients come back to the hospital is because they didn’t know [what to do],” Bruce explains. “If you have someone who can answer those questions, you can make appropriate referrals, either sending the patient to the emergency department [ED] or reaching out to the physician.”
The post-discharge texting program is a stopgap measure designed to provide continuity of care for the several days between discharge and a scheduled physician appointment.
“This is a key window of time,” Bruce says. “It’s also a key question time — a time when patients have frustrations and are feeling at a loss.”
The quick timing and friendly response to their questions may partially explain why patients received the program so well. “I can’t tell you how many text messages they forward to me that show profound gratitude,” Bruce says. “They say, ‘You really stepped up today and saved my day, and I don’t know how to thank you enough.’”
Patients thank the care coordinators who called them, showing a deep sense of gratitude. “That’s because of the people we hire,” Bruce adds. “We’re very care-driven; that’s our identity.”
High Engagement
Bruce and colleagues’ most interesting finding was the high engagement rates, which were comparable to and exceeded engagement rates in other post-discharge texting studies. Patients especially ranked the hospital high on its discharge process and said they would recommend the hospital. Physician and nurse communication was ranked high as well.1
“A major reason why we saw the outcomes is because of the team themselves, who they are, and the nature of their communication,” Bruce explains.
The texting program started in the quality department. They hired a couple of nurses to serve as transitioners, focused solely on recently discharged patients. They could work from home and have time flexibility based on data about when patient interactions are highest. For example, Mondays are an important day for patients’ questions because many patients have questions they could not get answered over the weekend. Holidays also are busy times.
“It’s now grown to be a seven-person team,” Bruce says. “It’s a combination of nursing and a pharmacist on staff.”
The team has a case manager/social worker. Patients’ questions are routed to the person best able to help them. If there are medication concerns, the question goes to the pharmacist.
Once the program was underway, leaders could see which types of questions appeared most often and make staffing decisions based on these data. “If there are mostly emergent questions, they will hire emergency nurses,” Bruce says. “We have an LPN nurse for post-discharge moms who had a baby, so the person reaching out to them is very knowledgeable in that area.”
Patients often are dissatisfied when they call a hospital line for help and are just told to call their physician’s office. They become frustrated when they cannot figure out what they are supposed to do, and they fail to reach someone who can give them an answer. “They don’t learn anything from that. It’s not the same as saying, ‘We’ll route you to the right place. We’ll be there for you,’” Bruce adds.
Patients seen in the ED also receive follow-up coordination through a text message, but those messages are automated. If an ED patient responds “yes” to a question, they are directed to return to the ED or to call their primary care provider.
“That’s a different mechanism that provides education through text messages,” Bruce says. “We use a combination of both — people texts and automated service.”
Surgical discharges also receive automated text messaging follow-up. “Patients discharged with total joint procedures are usually observation patients, and we ask them if they are experiencing any tenderness or redness that is concerning,” Bruce explains. “If the patient says ‘yes,’ we send an alert to the surgeon’s staff and say, ‘This patient responded in a concerning way.’ They will call the patient back, averaging in less than 15 minutes.”
Human Contact Is Important
Hospitalized patients are the ones who especially need the human touch. So far, the follow-up care text message programs have not caused problems for providers and staff. “They won’t get alert fatigue because they only hear from their own patients,” Bruce says.
For instance, surgeons might receive only a few alerts a week, which is manageable. They do not have to worry about overwhelming their staff.
“Patients love it because they don’t want to sit on hold forever or figure out which office to call and always wait for a phone call return,” Bruce adds.
The hospital does not send follow-up messages to patients who are transitioned to a rehab facility, skilled nursing facility, or another post-acute provider. “We find it can be annoying for someone to be at another place and trying to recover and still getting messages from their previous place,” Bruce explains. “We’re focused on the patients going home because they’re the most vulnerable, and they [may not] have anyone overseeing them.”
Bruce and colleagues found that readmissions were almost 30% lower at most of the health system’s seven campuses for patients with higher program engagement.1
“What’s interesting is we’ve done studies where we’ve looked at different text messages, and this is the only program we have found — for ourselves and in the literature — where it actually impacts, pretty significantly, patient experience scores,” Bruce says. “Our thought process is that it’s because it’s not automated; there’s someone behind it, and it’s a quick mechanism to get answers.”
It is a low-friction process from the perspective of patients. All they have to do is type “yes” to the text message, and minutes later they receive a call from someone who will answer their question or listen to their concerns. “Anything that is low friction for patients will result in a positive experience,” Bruce notes.
By contrast, automated text messages might not be low friction from a patient’s perspective. Sometimes, automated messages are inefficient, sending patients educational information they did not seek or need.
“This program was set up entirely from the patient’s experience. They want to reach someone quickly and with quick questions, and they don’t want to wait seven days to see someone for their answers,” Bruce explains.
Patients also want the human touch when they are worried. The care coordinators who call patients through the program provide personal, friendly care. Patients respond positively to this. “If I could guess, I think patients and society in general are frustrated by automation and the artificial intelligence [AI] world without the human touch,” Bruce adds. “I think people are asking to return to the old days of wanting a human to speak with.”
Every day, people find themselves interacting with technology, bots, and AI. If they purchase a product and have a question about it, they have to go through a chat room, often run by bots, which may or may not answer their specific concern or understand their dilemma.
“It’s the same for our patients,” Bruce says. “I like automation, and I think it does a lot for us. But if you really want to create the experience for patients, you have to find a way where patients can reach humans.”
Patients’ expectations are lower because of the rarity of human phone encounters when they call a business or organization. The patients served by the text messaging program were especially effusive when they received this service.
“They said we could have saved their life with this,” Bruce says. “There were so many incredible comments that lift up the morale of an overstretched care team. They know they do good work when the patient is actually effusive. I call it the smile file.”
REFERENCES
- Bruce C, Pinn-Kirkland T, Meyers A, et al. Investigating patient engagement associations between a postdischarge texting programme and patient experience, readmission and revisit rates outcomes. BMJ Open 2024;14:e079775.
- Bruce CR, Klahn S, Randle L, et al. Impacts of an acute care telenursing program on discharge, patient experience, and nursing experience: Retrospective cohort comparison study. J Med Internet Res 2024;26:e54330.
The results of a recent study revealed that a post-discharge texting program can greatly reduce readmissions and revisits. But there was a surprising finding: It can make patients happy or satisfied, as indicated by patient feedback on the program.
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