Text messaging post discharge as an efficient and costeffective

Transcription

1 Text messaging post discharge as an efficient and costeffective surveillance model McHugh SM, Corrigan MA, Murphy RKJ, Dhillon P, Shah A, Hennessy I, Sheikh A, Lehane E, Hill ADK 1. Department of Surgery, Beaumont Hospital, Dublin 9 2. Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2 3. Department of Nursing, University College Cork, Cork, Ireland

2 Introduction Currently 175,000 people are on outpatient waiting lists in Irish public hospitals The Health Service Executive (HSE) have set 90 days are their standard waiting time for routine outpatient appointments Waiting times exceed 100 days for general surgical clinics, and can reach up to 18 months in different surgical specialities

3 Figure: Beaumont Hospital outpatient appointment waiting times, February 2010 Introduction

4 Aim To develop and evaluate a novel outpatient follow up process to reduce unnecessary follow up, thereby facilitating the prompt investigation and diagnosis of new patients through changes in clinic profiles

5 Methods A Nokia 6700 mobile phone was used on a Vodafone pay as you go contract. Suitable emergency and elective admissions were recruited over a 4 month study period ending in June 2010

6 Methods From 8am to 5pm during the study period the phone was carried by different members of the surgical team on a rotational basis. Participating patients were sent an outpatient text message (OPT) at 2 weeks after their discharge from hospital enquiring after their progress. Patients were also requested to complete a Likert scale based survey carried out by text message assessing

7 Results Overall 55 patients were offered the service over the eight week period. The rate of uptake was 100%. Of these 62% (n=34) were female and 38% (n=21) male. 35% 30% 25% 20% 15% 10% 5% 0% Skin lesion Lap appendix Lap chole NSAP Other

8 Results Before the scheduled two week interval had passed, nine patients called the mobile phone number to contact the team. Of the 46 remaining patients, an OPT was sent at two weeks as per study protocol. 89% (n=41/46) of patients replied that they were well 11% (n=5/46) did not reply

9 Survey results 100% rated OPT as their preferred method of follow up 80% 60% 40% 20% 0% Extremely useful Very useful Moderately useful Minimally useful Not useful

10 Cost effectiveness Combined with the 49 cost of purchasing the phone the total study cost was With regards to cost saved, 41 visits to outpatients were avoided (13.5% decrease) There were five Emergency Department visits also avoided as described, representing a saving to the hospital of over 4,000euro

11 Discussion Advantages to surgical teams of using mobile technology alone in contrast to fixed landlines or personal computers: Quickly access to patient information Not limited to a fixed point or hospital computer in order to receive voice calls or ed images from concerned outpatients. No delays inherent in pulling and reviewing patient notes to attain contact details, and dialling through to hospital switchboards to access outside telephone calls

12 Discussion Advantages to patients: Ease of access patients can instantly access one a surgical team member familiar with their history and treatment plan. Avoids delays in patients accessing specialist surgical advice Also prevents delays in diagnosis and treatment were these patients to present to surgical teams on call unfamiliar with their cases.

13 Discussion The cost of a non trauma ED visit has been estimated at 295 US dollars per patient In Ireland, hospitals calculate the cost of outpatient appointments at 80 per patient A 5% decrease in absenteeism in public service workers alone would save over 3.2 million per year The entire study cost was just over 65

14 Conclusion Mobile technology improves two way communication between patients and surgical teams OPT improves outpatient efficiency, decreasing waiting times and improving the ratio of old to new patients OPT offers potential for significant cost savings in terms of unnecessary ED and OPD visits, as well as avoiding absenteeism from employment amongst our patient cohort

15 Thank you

16 Text messaging post discharge as an efficient and cost effective surveillance model McHugh SM, Corrigan MA, Murphy RKJ, Dhillon P, Shah A, Hennessy I, Sheikh A, Lehane E, Hill ADK 1. Department of Surgery, Beaumont Hospital, Dublin 9 2. Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2 3. Department of Nursing, University College Cork, Cork, Ireland