Just text me: A feasibility study of postoperative texting evaluations for gynecologic oncology patients (291)

Abstract

<b>Objectives:</b> Postoperative recovery is a stressful time for patients. As part of the standard of care, postoperative gynecologic oncology patients at the University of Pennsylvania Health System receive post-discharge phone calls by gynecologic oncology nurses to evaluate and recommend intervention as needed during patients' postoperative recovery. Given the high clinical volume, we aimed to determine if an automated text messaging program and healthcare innovation strategies, in lieu of routine telephonic nursing evaluations, could provide postoperative patient assessments that were comprehensive, were satisfactory to patients, and decreased provider clinical workload. <b>Methods:</b> English speaking patients undergoing surgery with four providers in the Division of Gynecologic Oncology at the University of Pennsylvania Health System from February 2021 to June 2021 were eligible for enrollment. Patients were offered routine telephonic evaluations by the gynecologic oncology nurses versus text message-based evaluations. Enrolled patients were texted 48 hours following discharge using an algorithm based on the Division's routine telephonic script. A "fake back end", i.e. a care team member who sent and responded to patient text messages, was utilized given the pilot nature of this study. Patients who did not respond were called by the nursing team to complete the remaining questions for evaluation. Patients with responses requiring further assessment were called by the nursing team for triage. Over the course of the pilot study, the algorithm was edited in response to patient and provider feedback. This program was approved by the Penn Medicine Institutional Review Board Quality Initiative and supported by the Center for Health Care Innovation. <b>Results:</b> Sixty-nine patients were approached for the program with 56 patients enrolling. Median age of enrollees was 54 years (IQR= 45.1-62.5). Basic demographics are provided in Table 1. The most common reason for declining the program was patient preference of telephone call. Of enrollees, 41 (73%) initiated the program. Of the 41 active enrollees, 18 (44%) completed the entire algorithm. Median time to completion of the algorithm was 34 (IQR 20-81) minutes. The 18 completed algorithms saved an estimated 4.5 hours of provider time. Reasons for non-completion were: 5 (22%) response indicated need for provider assessment, 3 (13%) algorithm error, and 15 (65%) patient non-response. Of the 17 enrollees who answered "On a scale of 0-10, how likely are you to recommend this texting program to a friend if they were getting the same procedure as you?" there were 13 promoters (9-10), 1 neutral participant (7-8), and 3 detractors (6 or less). Twelve participants responded with a score of 10/10. The lowest score was a 5 from a single patient. <b>Conclusions:</b> Text messaging programs for gynecologic oncology patients are feasible in providing efficient postoperative care and are satisfactory to patients. Further study is needed to determine the safety and scalability of automated patient evaluation text messaging platforms.