ABSTRACT
BACKGROUND: With the implementation of enhanced recovery after surgery protocols and same-day hospital discharge, patients are required to take on increasing responsibility for their postoperative care. Various approaches to patient information delivery have been investigated and have demonstrated improvement in patient retention of instructions and patient satisfaction. OBJECTIVE: This study aimed to evaluate the feasibility of implementing a postoperative text messaging service in the benign gynecologic population. METHODS: We used a quasi-experimental study design to evaluate patients undergoing outpatient laparoscopic surgery for benign disease with a minimally invasive gynecologist at an academic medical center between October 2017 and March 2018. In addition to routine postoperative instructions, 19 text messages were designed to provide education and support to postoperative gynecologic patients. Patients were contacted by telephone 3 weeks postoperatively and surveyed about their satisfaction and feelings of connectedness during their recovery experience. Demographic and operative information was gathered through chart review. The cost to implement text messages was US $2.85 per patient. RESULTS: A total of 185 patients were eligible to be included in this study. Of the 100 intended intervention participants, 20 failed to receive text messages, leaving an 80% success in text delivery. No patients opted out of messaging. A total of 28 patients did not participate in the postrecovery survey, leaving 137 patients with outcome data (control, n=75; texting, n=62). Satisfaction, determined by a score ≥9 on a 10-point scale, was 74% (46/62) in the texting group and 63% (47/75) in the control group (P=.15). Connectedness (score ≥9) was reported by 64% (40/62) in the texting group compared with 44% (33/75) in the control group (P=.02). Overall, 65% (40/62) of those in the texting group found the texts valuable (score ≥9). CONCLUSIONS: Postoperative text messages increased patients' perceptions of connection with their health care team and may also increase their satisfaction with their recovery process. Errors in message delivery were identified. Given the increasing emphasis on patient experience and cost effectiveness in health care, an adequately powered future study to determine statistically significant differences in patient experience and resource use would be appropriate.
ABSTRACT
OBJECTIVE: More evidence is required to endorse the 1-step approach for gestational diabetes mellitus (GDM) for clinical practice. Since 2010, our department has pragmatically allowed faculty to self-select the guidelines they use to screen and diagnose GDM. We sought to compare the maternal and neonatal outcomes from these two simultaneous cohorts. STUDY DESIGN: We performed a retrospective cohort study of all singleton pregnancies delivered between October 2011 and -November 2013 at our hospital. Patients were excluded if they had preexisting diabetes, were not screened or screened inappropriately, or their fetus had congenital anomalies. Patients were grouped by their screening strategy, and maternal and neonatal outcomes were analyzed. RESULTS: The 1-step group had a higher incidence of GDM (21.6% versus 5.0%). Initial results suggested higher rates of neonatal hypoglycemia, phototherapy for hyperbilirubinemia, and a lower rate of gestational HTN. After adjustment, these differences disappeared, but a lower rate of large for gestational age (LGA) infants was discovered (adjusted odds ratios (aOR) 0.78). CONCLUSION: The picture remains unclear as to whether the 1-step approach is associated with significantly improved outcomes compared with the 2-step approach. We did find a lower risk for a LGA infant in our 1-step cohort, but it is unlikely that the 1-step approach would be cost-effective due to the absence of other improved outcomes.
