Using an automated text messaging system as a communication tool proved to be handy for patient follow-up, specifically for ambulatory surgery patients who received a nerve block.1

Researchers found an automated text messaging system to query patients resulted in an average response rate of 91% among patients ages 18 to 90. This was higher than the rate of daily phone contact follow-up.

The traditional method of calling surgical patients after their procedure can be time-consuming and inefficient in an era when people do not answer calls they do not recognize.

“We mostly have trainees doing follow-up, and I did a lot of these calls when I was a trainee. It’s hard to get people on the phone sometimes,” says Daniel Gessner, MD, study co-author and clinical assistant professor in the department of anesthesiology, perioperative, and pain medicine at Stanford.

Sending follow-up messages via email or through an app that patients have to download on their phones also create barriers. Asking someone to download an app can create a technology barrier. Just as the volume of spam phone calls are on the rise, so, too, are the number of junk email messages.

“Imagining myself after surgery, and thinking about how I would like to communicate after surgery, I would like an option where I don’t have to answer the phone,” Gessner says. “Text messages can cut through a lot of the clutter.”

The key is to ask patients if it is OK to send a text message the next day for follow-up. “The vast majority of the patients we offered it to accepted it and wanted it,” Gessner reports. “We did not receive any rejected messages, and we didn’t have any patients who were unable to follow the instructions.”

The automated message asked patients if their nerve block had worn off, what time it wore off, and whether there were any leftover tingling sensations. “We asked if they were satisfied in their care, with a 1 for ‘yes,’ a 2 for ‘no,’ and a 3 for ‘not sure,’” Gessner explains.

The REDCap automated system did not accept invalid responses, such as a “no” answer when the question asked for a number response. “We had 12 of 85 patients who sent an invalid response at some point,” Gessner says. “Those 12 had some trouble, but they fixed it themselves and responded correctly.”

Text messages for follow-up are particularly useful during the COVID-19 pandemic, but their effectiveness suggests this is a method that could continue. “We’re still struggling to return to some normalcy. As we move back to thinking about normal changes, I’m looking forward to using it more,” Gessner says.

The method is affordable and can be used for other aspects of surgical practice. “There’s no limit to what you could ask patients as long as you have their permission,” Gessner offers.

A drawback to automated text messaging is it takes away the personal touch. “To be honest, I actually enjoyed these follow-up phone calls as a trainee,” Gessner says. “As an attending, I liked them too; it’s one of the few opportunities you have to feel like a doctor.”

A surgical professional’s daily experience involves few moments for real interactions with patients. “I enjoyed the phone calls, but they’re logistically challenging,” Gessner explains. “I do worry about losing the opportunity for personal interaction, a personal touch.”

Nevertheless, patients appear to like the text messages. “It’s important to respect patients’ time after surgery. If the patient doesn’t want to hear from you and be bothered, it’s up to them,” Gessner says.

If surgeons used text messages for more than an automated response system, then there is a chance it could lead to richer communication. “There could be some form of electronic communication, and it doesn’t have to be impersonal,” Gessner suggests. “It’s complicated because of security and privacy, but we should imagine the possibility of electronic communication that is easy to use, secure, and private — and that also has a human element to it.” 

REFERENCE

  1. Gessner D, Hunter OO, Kou A, Mariano ER. Automated text messaging follow-up for patients who receive peripheral nerve blocks. Reg Anesth Pain Med 2021;rapm-2021-102472.