Take two and text me in the morning: Optimizing clinical time with a short messaging system

BACKGROUND: Despite the widespread availability and convenience of short messaging systems, there has been limited adoption of this technology into the medical setting. Resistance may be attributable, in part, to the perceived lack of clinical benefit, privacy concerns, and a lack of physician compensation. This study evaluates the impact of a short messaging system clinical protocol between surgeons and patients. The endpoints evaluated were number of clinic visits, telephone calls, and days to surgical drain removal. METHODS: Retrospective review identified 102 procedure-matched patients who underwent breast reconstruction for an oncologic diagnosis. A short messaging system protocol was routinely used by one of the two study surgeons. Data collected included demographics, pathologic findings, procedures, complications, clinic visits, clinic telephone calls, days until drain removal, and episode of drain removal. RESULTS: The two groups were well-matched for age, procedure, race, complications, and pathologic findings. Patients in the short messaging system clinical protocol had statistically fewer clinic visits within the first 30 days (p = 0.0004) and 90 days (p = 0.017) postoperatively. There were fewer clinic telephone calls in the messaging group (p = 0.0002). The short messaging system protocol allowed for fewer days until drain removal (9.67 ± 0 .41 versus 12.45 ± 1.02, p = 0.013). Patients in the messaging group were more likely to undergo drain removal at the first clinic visit. CONCLUSIONS: Benefits of a short messaging system protocol included reduced number of clinic visits, fewer overall days of drain requirement, and increased efficiency of clinic visits. Concerns regarding physician privacy, compensation, and time need to be addressed before further application of this technology. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.