MyEDCare: Evaluation of a Smartphone-Based Emergency Department Discharge Process

 

 Permissions and Reprints

Abstract

Background Poor comprehension and low compliance with post-ED (emergency department) care plans increase the risk of unscheduled ED return visits and adverse outcomes. Despite the growth of personal health records to support transitions of care, technological innovation's focus on the ED discharge process has been limited. Recent literature suggests that digital communication incorporated into post-ED care can improve patient satisfaction and care quality.

Objectives We evaluated the feasibility of utilizing MyEDCare, a text message and smartphone-based electronic ED discharge process at two urban EDs.

Methods MyEDCare sends text messages to patients' smartphones at the time of discharge, containing a hyperlink to a Health Insurance Portability and Accountability Act (HIPAA)-compliant website, to deliver patient-specific ED discharge instructions. Content includes information on therapeutics, new medications, outpatient care scheduling, return precautions, as well as results of laboratory and radiological diagnostic testing performed in the ED. Three text messages are sent to patients: at the time of ED discharge with the nurse assistance for initial access of content, as well as 2 and 29 days after ED discharge. MyEDCare was piloted in a 9-month pilot period in 2019 at two urban EDs in an academic medical center. We evaluated ED return visits, ED staff satisfaction, and patient satisfaction using ED Consumer Assessment of Healthcare Providers and Systems (ED-CAHPS) patient satisfaction scores.

Results MyEDCare enrolled 27,713 patients discharged from the two EDs, accounting for 43% of treat-and-release ED patients. Of the treat-and-release patients, 27% completed MyEDCare discharge process, accessing the online content at the time of ED discharge. Patients discharged via MyEDCare had fewer 72-hour, 9-day, and 30-day unscheduled return ED visits and reported higher satisfaction related to nursing care.

Conclusion EDs and urgent care facilities may consider developing a HIPAA-compliant, text message, and smartphone-based discharge process, including the transmission of test results, to improve patient-centered outcomes.

Protection of Human and Animal Subjects

This case report summarizes a quality-improvement evaluation.

Publication History

Received: 28 December 2020

Accepted: 15 March 2021

Article published online:
28 April 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Engel KG, Buckley BA, McCarthy DM, Forth VE, Adams JG. Communication amidst chaos: challenges to patient communication in the emergency department. J Clin Outcomes Manag 2010; 17 (10) 17-21
  PubMedGoogle Scholar
• 2 Marty H, Bogenstätter Y, Franc G, Tschan F, Zimmermann H. How well informed are patients when leaving the emergency department? Comparing information provided and information retained. Emerg Med J 2013; 30 (01) 53-57
  CrossrefPubMedGoogle Scholar
• 3 Clarke C, Friedman SM, Shi K, Arenovich T, Monzon J, Culligan C. Emergency department discharge instructions comprehension and compliance study. CJEM 2005; 7 (01) 5-11
  CrossrefPubMedGoogle Scholar
• 4 Engel KG, Buckley BA, Forth VE. et al. Patient understanding of emergency department discharge instructions: where are knowledge deficits greatest?. Acad Emerg Med 2012; 19 (09) E1035-E1044
  CrossrefPubMedGoogle Scholar
• 5 Taylor DM, Cameron PA. Discharge instructions for emergency department patients: what should we provide?. J Accid Emerg Med 2000; 17 (02) 86-90
  CrossrefPubMedGoogle Scholar
• 6 McCarthy DM, Engel KG, Buckley BA. et al. Emergency department discharge instructions: lessons learned through developing new patient education materials. Emerg Med Int 2012; 2012: 306859
  CrossrefPubMedGoogle Scholar
• 7 Lawrence LM, Jenkins CA, Zhou C, Givens TG. The effect of diagnosis-specific computerized discharge instructions on 72-hour return visits to the pediatric emergency department. Pediatr Emerg Care 2009; 25 (11) 733-738
  CrossrefPubMedGoogle Scholar
• 8 Vashi A, Rhodes KV. “Sign right here and you're good to go”: a content analysis of audiotaped emergency department discharge instructions. Ann Emerg Med 2011; 57 (04) 315-322
  CrossrefPubMedGoogle Scholar
• 9 Samuels-Kalow ME, Stack AM, Porter SC. Effective discharge communication in the emergency department. Ann Emerg Med 2012; 60 (02) 152-159
  CrossrefPubMedGoogle Scholar
• 10 Bell EJ, Takhar SS, Beloff JR, Schuur JD, Landman AB. Information technology improves Emergency Department patient discharge instructions completeness and performance on a national quality measure: a quasi-experimental study. Appl Clin Inform 2013; 4 (04) 499-514
  Article in Thieme ConnectPubMedGoogle Scholar
• 11 Greene J. The barriers to care coordination: study probes why emergency physicians and primary care physicians don't talk to one another. Ann Emerg Med 2011; 58 (01) 15A-18A
  CrossrefPubMedGoogle Scholar
• 12 Katz EB, Carrier ER, Umscheid CA, Pines JM. Comparative effectiveness of care coordination interventions in the emergency department: a systematic review. Ann Emerg Med 2012; 60 (01) 12-23.e1
  CrossrefPubMedGoogle Scholar
• 13 Hunchak C, Tannenbaum D, Roberts M. et al. Closing the circle of care: implementation of a web-based communication tool to improve emergency department discharge communication with family physicians. CJEM 2015; 17 (02) 123-130
  CrossrefPubMedGoogle Scholar
• 14 Afilalo M, Lang E, Léger R. et al. Impact of a standardized communication system on continuity of care between family physicians and the emergency department. CJEM 2007; 9 (02) 79-86
  CrossrefPubMedGoogle Scholar
• 15 Charles D, King J, Furukawa M, Patel V. Hospital adoption of electronic health record technology to meet meaningful use objectives: 2008–2012. ONC data brief. 2013 . Accessed April 14, 2021 at: https://www.healthit.gov/sites/default/files/oncdatabrief10final.pdf
  PubMedGoogle Scholar
• 16 Children's Hospital Association, Sharing Data, Saving Lives: The Hospital Agenda for Interoperability. American Hospital Association. 2019 . Accessed April 14, 2021 at: https://www.childrenshospitals.org/Issues-and-Advocacy/Health-IT/Sharing-Data-Saving-Lives-Hospital-Agenda-Interoperability
  PubMedGoogle Scholar
• 17 Halamka JD, Mandl KD, Tang PC. Early experiences with personal health records. J Am Med Inform Assoc 2008; 15 (01) 1-7
  CrossrefPubMedGoogle Scholar
• 18 Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med Inform Assoc 2006; 13 (02) 121-126
  CrossrefPubMedGoogle Scholar
• 19 Bialostozky M, Huang JS, Kuelbs CL. Are you in or are you out? Provider note sharing in pediatrics. Appl Clin Inform 2020; 11 (01) 166-171
  Article in Thieme ConnectPubMedGoogle Scholar
• 20 My HealtheVet. Veterans Administration. Accessed February 15, 2021 at: https://www.myhealth.va.gov/mhv-portal-web/home
  PubMedGoogle Scholar
• 21 MyChart. Epic. Accessed February 15, 2021 at: https://www.mychart.com/
  PubMedGoogle Scholar
• 22 Gordon WJ, Henderson D, DeSharone A. et al. Remote patient monitoring program for hospital discharged COVID-19 patients. Appl Clin Inform 2020; 11 (05) 792-801
  Article in Thieme ConnectPubMedGoogle Scholar
• 23 Kruse CS, Argueta DA, Lopez L, Nair A. Patient and provider attitudes toward the use of patient portals for the management of chronic disease: a systematic review. J Med Internet Res 2015; 17 (02) e40
  CrossrefPubMedGoogle Scholar
• 24 Kruse CS, Bolton K, Freriks G. The effect of patient portals on quality outcomes and its implications to meaningful use: a systematic review. J Med Internet Res 2015; 17 (02) e44
  CrossrefPubMedGoogle Scholar
• 25 Nazi KM, Hogan TP, Wagner TH. et al. Embracing a health services research perspective on personal health records: lessons learned from the VA My HealtheVet system. J Gen Intern Med 2010; 25 (Suppl. 01) 62-67
  CrossrefPubMedGoogle Scholar
• 26 Goel MS, Brown TL, Williams A, Hasnain-Wynia R, Thompson JA, Baker DW. Disparities in enrollment and use of an electronic patient portal. J Gen Intern Med 2011; 26 (10) 1112-1116
  CrossrefPubMedGoogle Scholar
• 27 Hoek AE, Anker SCP, van Beeck EF, Burdorf A, Rood PPM, Haagsma JA. Patient discharge instructions in the emergency department and their effects on comprehension and recall of discharge instructions: a systematic review and meta-analysis. Ann Emerg Med 2020; 75 (03) 435-444
  CrossrefPubMedGoogle Scholar
• 28 Buckler LT, Teasdale C, Turner M, Schadler A, Schwieterman TM, Campbell CL. The patient-centered discharge—an electronic discharge process is associated with improvements in quality and patient satisfaction. J Healthc Qual 2017; 39 (03) 136-143
  CrossrefPubMedGoogle Scholar
• 29 Patel PB, Vinson DR. Physician e-mail and telephone contact after emergency department visit improves patient satisfaction: a crossover trial. Ann Emerg Med 2013; 61 (06) 631-637
  CrossrefPubMedGoogle Scholar
• 30 Walsh CA, Cahir C, Tecklenborg S, Byrne C, Culbertson MA, Bennett KE. The association between medication non-adherence and adverse health outcomes in ageing populations: a systematic review and meta-analysis. Br J Clin Pharmacol 2019; 85 (11) 2464-2478
  CrossrefPubMedGoogle Scholar
• 31 Russmann S, Curkovic I, Huber M. Adverse reactions and risks associated with non compliance. Ther Umsch 2010; 67 (06) 303-307
  CrossrefPubMedGoogle Scholar
• 32 Slater BA, Huang Y, Dalawari P. The impact of teach-back method on retention of key domains of emergency department discharge instructions. J Emerg Med 2017; 53 (05) e59-e65
  CrossrefPubMedGoogle Scholar
• 33 Garbers S, Peretz P, Greca E. Urban patient navigator program associated with decreased emergency department use, and increased primary care use, among vulnerable patients. J Community Med Health Educ 2016; 6: 440
  PubMedGoogle Scholar
• 34 Weinick RM, Becker K, Parast L. et al. Emergency department patient experience of care survey: development and field test. Rand Health Q 2014; 4 (03) 5
  PubMedGoogle Scholar
• 35 Willcox JC, Dobson R, Whittaker R. Old-fashioned technology in the era of “Bling”: is there a future for text messaging in health care?. J Med Internet Res 2019; 21 (12) e16630
  CrossrefPubMedGoogle Scholar
• 36 mHealth Economics 2017—Current Status and Future Trends in Mobile Health. Research 2 Guidance. 2019
  PubMedGoogle Scholar
• 37 Burke K. How many texts do people send every day? Text request. Published 2018. Accessed October 04, 2019 at: https://www.textrequest.com/blog/how-many-texts-people-send-per-day/
  PubMedGoogle Scholar
• 38 Klasnja P, Pratt W. Healthcare in the pocket: mapping the space of mobile-phone health interventions. J Biomed Inform 2012; 45 (01) 184-198
  CrossrefPubMedGoogle Scholar
• 39 Dobrilova T. 35+ Must-Know SMS Marketing Statistics in 2021. Published 2019. Accessed October 04, 2019 at: https://techjury.net/stats-about/sms-marketing-statistics/
  PubMedGoogle Scholar
• 40 Torous J, Nicholas J, Larsen ME, Firth J, Christensen H. Clinical review of user engagement with mental health smartphone apps: evidence, theory and improvements. Evid Based Ment Health 2018; 21 (03) 116-119
  CrossrefPubMedGoogle Scholar
• 41 Jaffe DH, Lee L, Huynh S, Haskell TP. Health inequalities in the use of telehealth in the United States in the lens of COVID-19. Popul Health Manag 2020; 23 (05) 368-377
  CrossrefPubMedGoogle Scholar
• 42 Irizarry T, DeVito Dabbs A, Curran CR. Patient portals and patient engagement: a state of the science review. J Med Internet Res 2015; 17 (06) e148
  CrossrefPubMedGoogle Scholar
• 43 Bloch SA, Bloch AJ. Using video discharge instructions as an adjunct to standard written instructions improved caregivers' understanding of their child's emergency department visit, plan, and follow-up: a randomized controlled trial. Pediatr Emerg Care 2013; 29 (06) 699-704
  CrossrefPubMedGoogle Scholar
• 44 Choi S, Ahn J, Lee D, Jung Y. The Effectiveness of Mobile Discharge Instruction Videos (MDIVs) in communicating discharge instructions to patients with lacerations or sprains. South Med J 2009; 102 (03) 239-247
  CrossrefPubMedGoogle Scholar
• 45 Hayes KS. Randomized trial of geragogy-based medication instruction in the emergency department. Nurs Res 1998; 47 (04) 211-218
  CrossrefPubMedGoogle Scholar
• 46 Ismail S, McIntosh M, Kalynych C. et al. Impact of video discharge instructions for pediatric fever and closed head injury from the emergency department. J Emerg Med 2016; 50 (03) e177-e183
  CrossrefPubMedGoogle Scholar
• 47 Nouri SS, Avila-Garcia P, Cemballi AG, Sarkar U, Aguilera A, Lyles CR. Assessing mobile phone digital literacy and engagement in user-centered design in a diverse, safety-net population: mixed methods study. JMIR Mhealth Uhealth 2019; 7 (08) e14250
  CrossrefPubMedGoogle Scholar
• 48 Schnellinger M, Finkelstein M, Thygeson MV, Vander Velden H, Karpas A, Madhok M. Animated video vs pamphlet: comparing the success of educating parents about proper antibiotic use. Pediatrics 2010; 125 (05) 990-996
  CrossrefPubMedGoogle Scholar
• 49 Williams DM, Counselman FL, Caggiano CD. Emergency department discharge instructions and patient literacy: a problem of disparity. Am J Emerg Med 1996; 14 (01) 19-22
  CrossrefPubMedGoogle Scholar