You've Got Mail … and Need Follow‐up: The Effect and Patient Perception of E‐mail Follow‐up Reminders After Emergency Department Discharge

Abstract

Objectives: The hypothesis was that a reminder about recommended primary care physician (PCP) follow-up, sent via e-mail to patients discharged from the emergency department (ED), would increase the proportion of patients who followed up with their PCPs within the recommended time frame. Patient receptiveness to e-mail follow-up reminders was also assessed.Methods: This was a mixed methods clinical intervention study with subjects randomized either to receive the usual care discharge instructions only or to also receive a reminder e-mail message the day after the ED visit. The reminder e-mail contained the subject's PCP's name and address and the recommended PCP follow-up time interval. A blinded review of outpatient PCP medical records was conducted to determine whether and when follow-up occurred. Researchers attempted to contact patients with a telephone survey 2 weeks after their ED visits. The primary outcomes between groups were compared using chi-square tests and relative risks (RRs) with 95% confidence intervals (CIs).Results: Thirty-three percent of the intervention group and 32% of the control group followed-up as recommended (RR = 1.04, 95% CI = 0.81 to 1.33); 52% of the intervention group and 48% of the control group followed-up within 10 days of the recommended time (RR = 1.08, 95% CI = 0.91 to 1.29). The 334 patients (57%) successfully contacted via telephone demonstrated a high interest in receiving future e-mail reminders (75%), with the group that received e-mail reminders more likely to want one in the future than those who did not receive e-mail reminders (82.5% vs. 69.76%; p = 0.04).Conclusions: E-mail reminders sent after ED visits did not improve patients' adherence to the recommended timing of primary care follow-up contained in discharge instructions. Subjects in both the control and the intervention groups favorably viewed the concept of e-mail reminders, suggesting that the value of e-mail reminders after ED discharge may be in areas such as patient satisfaction that were not specifically targeted for measurement in this study.ACADEMIC EMERGENCY MEDICINE 2015;22:47-53 © 2014 by the Society for Academic Emergency Medicine O utpatient follow-up care of patients discharged from the emergency department (ED) is critical to ensuring continuity of care and optimal patient outcomes. Primary care physician (PCP) followup rates after ED care as low as 24% to 50% have been demonstrated in both urban and suburban hospitals. 1,2Prior studies have demonstrated that ED patients have difficulty understanding their discharge instructions, with 34 and 31.5% of patients in separate studies demonstrating confusion regarding their ED follow-up care. 3,4 Multiple approaches to improve follow-up rates after ED care have been attempted. [5][6][7] In one of the first attempts to improve patient compliance with follow-up appointments after ED visits, a 1970s study noted an increase from 58% to 80% when patients were telephoned with appointment reminders the day after their

Telephoned, Texted, or Typed Out: A Randomized Trial of Physician–Patient Communication After Emergency Department Discharge

“…The outcome of patient satisfaction has been shown to be positively correlated with patient compliance and adherence to treatment (18–19); thus, the use of low-cost methods such as phone callbacks or text messaging to improve patient satisfaction has the potential of improving patient outcomes. Both of these methods of follow-up contact have been favorably received by patients both in the ED and in other clinical settings (2,10,20–21) indicating the potential for their use as methods of non-intrusive post-visit communication between physicians and patients.…”

Do Parents of Discharged Pediatric Emergency Department Patients Read Discharge Instructions?

“…Multiple DCI delivery methods have been proposed and evaluated, including watching an instructional discharge video in the ED 15,16 or online from home, 17 e-mail reminders, 18 follow-up text messages, 19 and even recording audio or visual instructions on the patient's smartphone. Future research may explore the success of different methods with specific patient populations, targeting those who are least likely to read paper DCIs; however, until these studies are performed, providers must work harder to deliver clear, thorough verbal instructions at the time of discharge from the ED.…”

Common step-wise interventions improved primary care clinic visits and reduced emergency department discharge failures: a large-scale retrospective observational study

“…Patients without a dedicated PCP are also reported to have relatively poor follow-up visit compliance [12, 13]. Realizing these potential contributing factors, different combinations of the following interventions were implemented to improve follow up compliance: providing charity insurance, assigning a dedicated PCP, and providing a phone call or text message to remind patients of post-ED discharge clinic appointments [11, 13, 14]. We assumed that increased patient clinic follow-up compliance would eventually decrease inappropriate ED utilization and/or returns.…”

“…However, the value of these interventions is varied when analyzing the literature. This variation is due to different interventions rendered in different studies without use of standard outcome measurements [2, 10, 14, 15], thereby requiring further external validation.…”