Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States.
NewYork-Presbyterian Hospital, New York, New York, United States.
Appl Clin Inform. 2021 Mar;12(2):362-371. doi: 10.1055/s-0041-1729165. Epub 2021 Apr 28.
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.
We evaluated the feasibility of utilizing MyEDCare, a text message and smartphone-based electronic ED discharge process at two urban EDs.
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.
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.
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.
较差的理解能力和对 ED（急诊部）后护理计划的低遵从度增加了非计划性 ED 复诊和不良结局的风险。尽管个人健康记录的发展有助于支持护理交接，但技术创新对 ED 出院流程的关注一直有限。最近的文献表明，纳入 ED 后护理的数字通信可以提高患者满意度和护理质量。
我们评估了在两家城市 ED 中使用 MyEDCare（一种基于短信和智能手机的电子 ED 出院流程）的可行性。
MyEDCare 在患者出院时向其智能手机发送短信，其中包含指向符合 HIPAA（健康保险便携性和责任法案）的网站的超链接，以提供患者特定的 ED 出院医嘱。内容包括治疗信息、新药物、门诊护理安排、复诊预防措施以及在 ED 进行的实验室和放射学诊断测试的结果。向患者发送三条短信：ED 护士协助初始访问内容时、ED 出院后 2 天和 29 天。MyEDCare 在 2019 年在一家学术医疗中心的两家城市 ED 进行了为期 9 个月的试点。我们使用 ED 患者对医疗保健提供者和系统的评估（ED-CAHPS）患者满意度评分评估 ED 复诊、ED 工作人员满意度和患者满意度。
MyEDCare 招募了来自两家 ED 的 27713 名出院患者，占治疗后出院患者的 43%。在治疗后出院的患者中，有 27%完成了 MyEDCare 出院流程，在 ED 出院时访问了在线内容。通过 MyEDCare 出院的患者 72 小时、9 天和 30 天的非计划性复诊 ED 就诊较少，且与护理相关的满意度较高。
ED 和紧急护理机构可能考虑开发符合 HIPAA 的短信和基于智能手机的出院流程，包括测试结果的传输，以改善以患者为中心的结果。
