Abstract
BACKGROUND: Emergency department (ED) overcrowding and avoidable revisits challenge health systems, with approximately 20% of patients returning within 30 days. ED-based transitional care interventions, including automated SMS text messaging, offer scalable, cost-effective means to improve follow-up, though evidence remains limited. OBJECTIVE: This study evaluated a transitional care intervention combining SMS text messaging and virtual transitional care visits to reduce ED revisits and improve outpatient follow-up. METHODS: This retrospective observational cohort study included patients discharged from 4 EDs within a single US health system between September 2023 and September 2024. Patients were categorized into two groups based on intervention engagements: (1) completed (requested, scheduled, and completed a visit) and (2) noncompleted (requested, scheduled, and did not complete). The primary outcome was spontaneous, unplanned ED revisits within 90 days; secondary outcomes included outpatient follow-up and time to first outpatient evaluation. Between-group differences were assessed using descriptive statistics and multivariable regression models (with P<.05 considered statistically significant). RESULTS: Of 68,115 discharged patients, 42.72% (29,100/68,115) received an automated SMS text messaging for the virtual transitional care program, and 2.93% (853/29,100) accessed the scheduling link. Of these, 56.5% (482/853) requested a visit, 49.8% (240/482) scheduled, and 70% (168/240) completed the visit (completed group). Among 72 noncompleted patients, 57% (n=41) did not show, 32% (n=23) canceled, and 11% (n=8) scheduled 2 appointments but completed neither. Nearly half (35/72, 49%) of the noncompleted group had a subsequent ambulatory follow-up. Demographics, comorbidities, and acuity were similar. The noncompleted group was nearly twice as likely to return to the ED within 90 days (21/72, 29% vs 28/150 18.7%; χ21=4.20, P=.04; odds ratio 2.11, 95% CI 1.02-4.33), while the completed group was more likely to complete outpatient follow-up (35/72, 49% vs 51/168, 30.4%; χ21=6.60, P=.01; odds ratio 2.15, 95% CI 1.03-4.77). Time to first outpatient visit did not differ significantly between groups (mean 15.7, SD 19.0 d vs mean 19.8, SD 20.7 d; Δβ=-1.93, 95% CI -10.09 to 6.42; P=.65). CONCLUSIONS: A combined SMS text messaging and virtual transitional care program lowered 90-day ED revisits and increased outpatient follow-up, but engagement was low (2.9%). Future work should focus on optimizing care delivery and developing strategies to expand reach across the broader ED discharge population.