Business Advisor

We all know the challenges of reaching patients by phone in the days before surgery. Reaching the young parents of pediatric patients to communicate critical info might be even more difficult. Mom and Dad are seemingly always on the go: working, driving, or at the supermarket or Little League game when a nurse tries to reach them by phone late in the afternoon — either unable to pick up the phone or to write down the instructions. And sometimes we can’t even leave a message because their voice mailboxes are full.

It’s clearly faster and easier to reach most parents through text. Studies show that only 1 in 5 people answer calls they aren’t expecting, while the average person reads a text within 5 seconds (unless they’re driving, of course!). Talk about instant messaging.

According to industry statistics, the average cell phone owner under 45 years old sends and receives about 85 texts every day. Apparently, though, very few of those texts come from surgical facilities. According to last month’s online poll by Outpatient Surgery Magazine, only 12% of 242 respondents send patients automated texts. Another 23% said they hoped to begin texting.

But as patient satisfaction and convenience become increasingly important to healthcare facilities, texting is one way we can better serve the needs of patients and families.

“It was so nice to get your text,” we’ll often hear. And our repeat patients — those who’ve had transplants and need liver biopsies or those with facial hematomas receiving laser treatment — will often tell our nurses, “Just text me next time” to remind them of their appointment.

Even though we’ve incorporated texting into our pre-op communications, we still do some things the traditional way. We don’t let patients register and record their medical information online, and we’ve yet to integrate the texting system with our EHR. And we haven’t done away with the pre-op phone call. One of our nurses calls every patient’s parent about 3 days before surgery to review the child’s medical history and to take a health history. We haven’t eliminated the phone call in case the parent has a question for the nurse. During this initial call, the nurse asks Mom or Dad for a secure phone number on which they’d like to receive text alerts from us. Our automated system sends a confirmation text during the call to ensure receipt.

Soon after we hang up, parents receive a standardized text that includes the date of surgery, our address and phone number, as well as links to our site about anesthesia and same-day surgery. We’re limited to 160 characters per text, so we must be succinct.

One day before surgery, we’ll call and text parents again to give NPO instructions and to remind them of the arrival time. For pediatric patients, NPO times can vary. We created texts for clear liquids (water, Gatorade or plain, clear apple juice) up to 2 hours before surgery, breast milk up to 4 hours, formula up to 6 hours and thickened feed for patients who have trouble swallowing up to 8 hours. Parents find it helpful that our texts state the time that their child should stop drinking whichever liquid.

If you’d like to implement a texting system, give yourself a lot of time to smooth out the technological kinks. It took us a year to launch, a lot longer than we’d initially thought. We had a few starts and stops along the way.

• 160 characters. We worked long and hard with our texting vendor to customize our messages, but it’s not easy summarizing NPO instructions in less than 160 characters. That’s precious few words, trust us. We wanted the instructions to be clear, but we worried if too little info would be helpful.
• Frequency. Outpatient areas of Children’s Hospital of Pittsburgh were already using the cloud-based messaging platform, but it took some trial and error to synchronize sending multiple texts over multiple days — rather than sending, for example, a single text about the expected ER wait time.
• Daily patient database. Each day, we place what we call a daily drop of patients into the texting database. When we launched our service, however, we failed to filter out canceled patients and inpatients, so early on both these groups received texts not intended for them. Our IT team was quick to fix this glitch so that we can upload the patient Excel file to our vendor for the next 7 days.
• Staff pushback. We initially had some pushback from our phone call nurses who felt the program would be too time- and labor-intensive for them to manually key in patient data into the texting module. But when they saw how intuitive the program is — it automatically computes NPO times once you enter the patient’s arrival time — and that they were playing a lot less phone tag, they were full-steam ahead.

We expected that texting would improve our no-show and NPO compliance rates. It has, but not by much. The decrease in NPO violations has been barely perceptible: 0.22% in 2017 to 0.20% so far this year. Parents might misread apple juice as apple sauce. Some mothers have a hard time denying their hungry, crying child breast milk. And, of course, some industrious kids just can’t help sneaking a snack unbeknownst to their parents.

The cost is reasonable. We spent about $6,000 to build and customize our ambulatory surgery texting app and pay another $6,000 per year based on texting 100 patients daily — about 60 hospital patients and 40 surgery center patients per day. But you really can’t set a price on a text’s magical ability to help ease parents’ stress about their child’s surgery. OSM