BACKGROUND: Automated text messaging systems (ATMS) are increasingly used to support perioperative care in total joint arthroplasty. However, their effect on patient-initiated communication patterns and clinical workflow remains incompletely defined. This study evaluated changes in perioperative phone call and portal message volume following implementation of an ATMS in a high-volume arthroplasty practice.
METHODS: Patient-initiated phone calls and secure portal messages were prospectively tracked during the 2-week preoperative and postoperative periods for patients undergoing primary total joint arthroplasty before and after ATMS implementation. Two sequential cohorts were compared: preimplementation (n = 145) and postimplementation (n = 101). Communications were categorized by modality, timing, and topic. Zero-inflated negative binomial regression was used to assess differences in communication volume, adjusting for age.
RESULTS: Patient-initiated phone calls decreased from 2.23 ± 2.87 per patient before implementation to 1.24 ± 1.83 after implementation. In age-adjusted models, the postimplementation cohort had a 44% lower phone-call rate (incidence rate ratio 0.56, 95% confidence interval 0.39-0.80; P = .001). Portal message volume and total communications did not differ significantly between cohorts. These findings demonstrate an association between ATMS implementation and fewer phone calls, but do not establish a compensatory increase in portal messaging or a reduction in overall communication volume.
CONCLUSIONS: Implementation of an ATMS was associated with fewer perioperative patient-initiated phone calls, while portal message volume and total communication volume were not significantly different. Given the sequential pre-post design, these findings should be interpreted as an association rather than a direct causal effect. Further controlled studies are needed to evaluate effects on staff workload, efficiency, cost, and patient experience.
Read the article: PubMed · Publisher (DOI)