Follow-Up Scheduling for ER Patients

Overseen By Amir Goren, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Geisinger Clinic

Disqualifiers: Scheduled appointment, Institutionalized, Unreachable, Admitted, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if reminders to schedule follow-up appointments after an emergency room visit can reduce unnecessary future visits. Participants will receive either one or two text message reminders, or no messages, about setting up these appointments. The study will assess whether the reminders encourage people to book and attend these follow-ups. It suits those recently discharged from a high-acuity emergency room visit who have not scheduled a follow-up within the next week and are connected to a Geisinger primary care doctor. As an unphased trial, this study offers participants the opportunity to contribute to innovative research that could enhance healthcare follow-up practices.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this follow-up scheduling protocol is safe?

Research shows that sending text messages to remind patients about follow-up appointments after an emergency room visit is generally safe and effective. Studies have found that these messages increase attendance at scheduled follow-up visits.

No major reports of problems have emerged from receiving text message reminders. In fact, many patients appreciate them, with approval ratings ranging from 77% to 96%. This indicates that most people find these reminders helpful rather than annoying.

Overall, text message reminders for medical appointments are well-received and effectively boost attendance at follow-up visits, making them a safe choice for patients. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores innovative ways to improve follow-up care for ER patients using technology. Unlike traditional methods where patients might need to remember to schedule follow-ups on their own, this trial tests the use of text message reminders and online scheduling options to streamline the process. By receiving reminders and information directly on their phones, patients can easily schedule their follow-up appointments, potentially leading to better health outcomes by ensuring they receive the necessary care without delay. This approach is particularly promising as it leverages technology to enhance patient engagement and adherence to recommended follow-up care.

What evidence suggests that this trial's outreach methods could be effective in reducing unnecessary ED visits?

Research has shown that automated text messages for scheduling follow-up appointments can increase patient attendance. In this trial, one group will receive a single text message, while another will receive two messages, both offering information on scheduling a follow-up appointment. For instance, one study found that patients who received both text and phone messages were more likely to attend their follow-up appointments 30 and 120 days after leaving the emergency room. However, another study found that text messages did not significantly reduce urgent care visits after discharge. Overall, automated text messaging is a promising and cost-effective method to boost follow-up visits, ensuring patients receive appropriate care after leaving the emergency room. ^{6 7 8 9 10}

Who Is on the Research Team?

Amir Goren, PhD

Principal Investigator

Geisinger Clinic

Are You a Good Fit for This Trial?

This trial is for patients who have had a high-acuity visit to the emergency department (ED). It's designed to see if follow-up reminders can help them get appropriate care outside of the ED. To participate, individuals must be able to receive text messages and use hyperlinks.

Inclusion Criteria

Attributed to a Geisinger PCP in Community Medicine Service Line

Discharged from ED in past 24 hours

My last ER visit was for a very urgent issue.

Exclusion Criteria

I have a follow-up appointment within a week after leaving the hospital.

Institutionalized

Cannot be contacted via the communication modality being used in the study (i.e., SMS), due to insufficient/missing contact information in the electronic health record or because the patient opted out

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive outreach via text message and information in their after visit summary to schedule a follow-up appointment

1-8 days

1-2 messages sent post-ED discharge

Follow-up

Participants are monitored for ED visits and follow-up appointment attendance

120 days

What Are the Treatments Tested in This Trial?

Interventions

• Information about scheduling a follow-up appointment

Trial Overview

The study tests whether sending a text message with information on scheduling a follow-up appointment with primary care or specialists after an ED visit reduces unnecessary future ED visits. Some will receive this outreach; others won't, to compare outcomes.

How Is the Trial Designed?

Group I: Experimental: Schedule Follow-Up Visit - 2 messages Experimental Treatment 1 Intervention

This arm will receive text messages (at 1 day and 8 days post-ED discharge) and information added to the patient's after visit summary providing a number and patient portal hyperlink via which to schedule an ED follow-up appointment.

Group II: Experimental: Schedule Follow-Up Visit - 1 message Experimental Treatment 1 Intervention

This arm will receive a text message (at 1 day post-ED discharge) and information added to the patient's after visit summary providing a number and patient portal hyperlink via which to schedule an ED follow-up appointment.

Group III: Control Active Control 1 Intervention

This arm will receive no intervention outside of usual care.

Who Is Running the Clinical Trial?

Geisinger Clinic

Lead Sponsor

Trials

159

Recruited

1,976,000+

Published Research Related to This Trial

Providing follow-up appointments (FA) directly in the pediatric emergency department significantly improved compliance, with 47% of patients in the appointment group and 52% in the intense group attending their follow-ups, compared to only 24% in the control group.

Successful telephone reminders further increased compliance to 62%, highlighting the importance of direct assistance in appointment-making, but the study found no long-term changes in appointment behavior or emergency department usage after the intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of interventions to improve clinic follow-up compliance after a pediatric emergency department visit. Komoroski, EM., Graham, CJ., Kirby, RS.[2019]

Involving patients in scheduling their follow-up appointments led to a significant increase in successfully scheduled appointments (from 66.7% to 87.7%) and improved attendance rates (from 43.9% to 62.9%).

The addition of a dedicated discharge scheduler reduced the administrative burden on residents, with 100% of participating residents reporting that this change improved their ability to care for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Measuring Patient Preferences and Clinic Follow-Up Utilizing an Embedded Discharge Appointment Scheduler: A Pilot Study. Berger, RE., Yang, S., Weiner, J., et al.[2020]

Only 23% of calls to ambulatory clinics resulted in an appointment within one week, highlighting significant barriers to timely follow-up care for emergency department patients.

43% of initial calls to clinics were unsuccessful due to issues like clinic closures and busy signals, indicating that logistical challenges, rather than cost, are major obstacles in accessing necessary follow-up care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nonprice barriers to ambulatory care after an emergency department visit. Vieth, TL., Rhodes, KV.[2008]

Implementing an appointment assignment system in emergency departments significantly improved patient follow-up compliance and reduced the rate of unscheduled return visits to the ED.

This patient-centered approach not only enhances access to care but also strengthens the overall continuum of care, leading to better quality and increased patient satisfaction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Facilitating follow-up after emergency care using an appointment assignment system. Vinson, DR., Patel, PB.[2019]

A multicentric follow-up study showed that contacting outpatients after an emergency department visit is feasible, with high success rates of 78.6% to 85.6% regardless of whether the follow-up occurred at 1, 2, or 4 weeks after the visit.

The study found that about 50% of patients could be reached on the first call, indicating that timely follow-up is possible and may help ensure that outpatient services meet patient needs effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outpatient care in emergency departments: feasibility and comparison of three strategies for follow-up. Houzard, S., Pateron, D., Bleichner, G., et al.[2018]

A telephone follow-up system in the emergency department successfully reached 81% of patients, helping to clarify discharge instructions and address any concerns, which is crucial for improving patient compliance and satisfaction.

The follow-up calls led to direct medical interventions for most patients who reported worsening conditions, highlighting the system's effectiveness in enhancing patient care post-discharge.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of a telephone follow-up system in the emergency department. Jones, J., Clark, W., Bradford, J., et al.[2019]

Implementing a patient-centered follow-up plan, where patients had their outpatient appointments scheduled at the time of emergency department discharge, significantly reduced the rate of return visits to the ED.

The project involved patients with low-acuity complaints and demonstrated that proactive scheduling or follow-up calls within 2 days can effectively improve outpatient follow-up and decrease unnecessary ED revisits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving Outpatient Follow-Up Through Innovative Appointment Scheduling at Emergency Department Discharge. Tessitore, A., Brennan-Cook, J.[2021]

An automated self-scheduling phone system significantly improved follow-up appointment adherence for patients discharged from the emergency department, with 49.3% of those using the system keeping their appointments compared to only 23.4% in the control group.

Despite the increase in follow-up adherence, the automated reminders did not lead to a reduction in return visits to the emergency department within 120 days post-discharge.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving Follow-up Attendance for Discharged Emergency Care Patients Using Automated Phone System to Self-schedule: A Randomized Controlled Trial. Bauer, KL., Sogade, OO., Gage, BF., et al.[2022]

Patients who visit emergency departments during times of long waiting periods face a higher risk of adverse events, such as hospital admission or death, particularly if they are high acuity patients.

However, patients who leave the emergency department without being seen do not show an increased risk of short-term adverse events, suggesting that their decision to leave may not be harmful.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. Guttmann, A., Schull, MJ., Vermeulen, MJ., et al.[2022]

In a study of 311 patients returning to the emergency department within a week, 79.6% returned due to issues related to their initial visit, indicating a significant rate of unresolved problems.

The evaluation revealed that 21.2% of these return visits had consequences for patients, with 30.5% of those cases deemed avoidable, highlighting areas for improvement in emergency care and patient safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Adverse events in emergency departments. Review of reconsultations as a data source]. Martínez, JA., Linares, ML., Soler, MA., et al.[2010]

An automated text message reminder system significantly improved attendance at follow-up appointments after emergency department discharge, with a per-protocol adherence rate of 72.6% compared to 62.1% in the control group.

This intervention was particularly beneficial for patients with lower baseline follow-up rates, suggesting that text reminders could be a cost-effective and scalable solution to enhance patient engagement in their healthcare.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving attendance at post-emergency department follow-up via automated text message appointment reminders: a randomized controlled trial. Arora, S., Burner, E., Terp, S., et al.[2022]

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