P0973 - Institution-initiated Text Messaging and Telehealth Services Can Reduce Emergency Department Visits After Appendectomy.

Background/

Purpose: Many post-appendectomy emergency department (ED) visits can be prevented with a phone call or non-emergent clinic visit. We developed an intervention to reduce ED visits for minor complaints in post-appendectomy patients through proactive institution-driven communication and utilization of telehealth resources.

Methodology: We developed a text messaging system to initiate communication with parents of appendectomy patients and connect them with a telehealth visit or phone call with a surgical provider as needed. Using descriptive statistics, chi square and statistical process control analytics, we compared rates of postoperative ED visits for the eight months pre- and post-implementation of the messaging system, and summarized the feedback we received from parents.

Discussion: A total of 791 appendectomies were performed in two institutions between September 2018 - December 2019 (pre-intervention = 382, post-intervention = 409). The postoperative ED visit rate decreased from 5.7% pre-implementation to 2.4% post-implementation (p=0.02). This decrease began one month prior to implementation of the pathway, when education about the system was being rolled out to the surgical team. The reduction was sustained for the entire study period (Figure). Over one-fifth of families messaged (21.6%) had questions regarding their child’s postoperative course, with 52% expressing interest in a video chat with a telemedicine physician and 25% preferring to speak with the surgeon’s office. Over 90% of respondents found the system helpful, and only 4.9% chose to opt out. There were 13 telehealth visits carried out and all were successful in addressing the family member’s primary concern. On follow up with these 13 families, 4 (31%) said that they would have gone to the ED or an urgent care facility if they did not have the opportunity to have a video visit.

Conclusion: Implementation of a hospital-initiated text messaging system in conjunction with telehealth services reduces preventable ED visits after appendectomy.