Another strategy to increase patient engagement is mobile text messaging. Research shows that text reminders can increase attendance at scheduled medical appointments21 and can help increase daily medication adherence in patients with HIV, hypertension, and other chronic conditions.6,22,23 Mobile text-based interventions have been used in ED care to engage patients in followup planning and encourage treatment adherence.8,24,25
In one randomized controlled trial, adolescent ED patients diagnosed with pelvic inflammatory disease were significantly more likely to follow up as recommended if they received personalized text messages compared with patients who received no message.8 In a study of adult ED patients, text messaging reminders significantly increased the rate of adherence to post-ED followup appointments.25
Similarly, postdischarge texts from the ED could be used to evaluate and improve diagnostic safety. This concept was recently explored in one small randomized control trial assessing the use of text messaging to facilitate postdischarge conversations between patients and ED physicians.26 Patients who received a followup text (which asked patients if they wanted to speak with a physician) 48 hours after ED discharge had lower rates of ED revisits compared with those who did not receive a text message. In addition, using text messages to solicit patient-reported diagnostic errors after ED discharge is in the preliminary phases of study.27
Although not yet studied, postdischarge texts could also be deployed to remind patients to review outstanding test results in their portal or prompt patients to follow up with their PCP for additional diagnostic testing if indicated. Finally, text messages after ED discharge might provide explicit instructions related to the diagnosis and relay important return visit precautions if the patient’s condition fails to improve as expected.
Future studies should explore the role of text messaging in the post-ED discharge diagnostic process. They should also examine the effectiveness of text-based interventions and patient preferences about types of messaging desired, including educational, motivational, or informational.28 Barriers to using this method of communication, such as costs to patients (based on mobile carrier plan) and concerns about patient privacy when disclosing sensitive medical information via mobile texting, require further investigation.29,30 Codesigning the technologies with patients and soliciting input regarding intent, frequency, and content of the communication prior to widespread deployment in the ED are paramount.
