Developing an Automated Text Message Program in the Emergency Department

Patients in emergency departments (EDs) often face barriers to care, including complex operations, long waits, and limited communication from care teams. These factors contribute to dissatisfaction and may increase rates of leaving before treatment is complete. Automated text messaging (SMS) may improve transparency by providing real-time updates and answering common patient questions about comfort and visit milestones. This pilot study evaluated the feasibility of implementing a fully automated SMS program and describes key aspects of its design and implementation.

SMS content and triggering logic were developed through informal patient interviews and iterative input from a multidisciplinary team, including physicians, nurses, registration staff, and patient experience administrators. Messages were mapped to electronic health record (EHR) events and triggered automatically without staff intervention. Following deployment, a convenience sample of English-speaking, adult patients at a single urban academic ED were offered enrollment over a 15-month period. Enrolled patients received an optional, anonymous post-visit survey. Data on enrollment and survey results were summarized descriptively.

Thirteen automated messages were implemented. Between July 2023 and October 2024, 4,100 of 42,915 eligible patients enrolled (9.6%). Among enrollees, 185 completed the post-visit survey (4.5%). Of respondents, 89.7% reported wanting text messages during their ED visit. The most frequently selected desired topic was "updates on what tests/procedures are still pending" (65.4%).

A fully automated ED SMS communication program was technically feasible and was viewed favorably by survey respondents. Future work should evaluate strategies to increase enrollment and engagement, assess implementation in other settings, and examine the impact of automated messaging on patient experience.