JMIR Publications

ABSTRACT

Background:

With the implementation of enhanced recovery after surgery protocols and same day hospital discharge, patients are required to take on increasing responsibility for their postoperative care. Various approaches to patient information delivery have been investigated and have demonstrated improvement in patient retention of instructions and patient satisfaction.

Objective:

To evaluate the feasibility of implementing a postoperative text messaging service in the benign gynecologic population.

Methods:

Quasi-experimental study design evaluating patients undergoing outpatient laparoscopic surgery with a minimally invasive gynecologist for benign surgery at an academic medical center between October 2017 and March 2018. In addition to routine postoperative instructions provided to all patients, 19 SMS text messages were designed to provide education and support to intervention patients. All patients were contacted by telephone 3 weeks postoperatively and surveyed about their satisfaction with the recovery process and feelings of connection to their healthcare team. Basic demographic and operative information was gathered through chart review. The cost to send 19 text messages was $2.85 per intervention patient.

Results:

A total of 185 patients were eligible to be included in this study. Of the 100 intended intervention participants, 20 failed to receive text messages, leaving an 80% success in text delivery. No patients opted out of messaging after receiving the initial welcome text message. A total of 28 patients did not participate in the post-recovery survey, leaving 137 patients with outcome data (control, N=75; texting, N=62). Satisfaction, determined by a score of ≥9 on 10-point scale, was 74% in the texting group and 63% in the control group (p=.15). Connectedness (score ≥9) in the texting group was 64% compared to 44% in the control group (p=.02). Overall, 65% of those in the texting group found the texts valuable (score ≥9). Control group patients undergoing uterine sparing procedures had lower satisfaction (p=.02) and connection (p=.008) scores at baseline compared to control patients undergoing hysterectomy. However, differences in satisfaction and connection scores between the hysterectomy and uterine sparing groups were eliminated with the texting intervention.

Conclusions:

Implementation of a postoperative text messaging service is feasible in the benign gynecologic population. Errors in message delivery were identified and can be remedied in future study. Introducing text messages demonstrated a trend toward increased patient satisfaction with recovery and statistically significant increase in perception of connection to the healthcare team. The trend was more pronounced in patients undergoing uterine sparing procedures. Given the increasing emphasis on patient experience and cost effectiveness in healthcare, an adequately powered future study to determine statistically significant differences in patient experience and resource use would be appropriate.