Parent education by text reduces ED visits for nonurgent care

Michael G Burke, MD

Frequently sending texts to caregivers with messages about infant development, safety, and basic care reduces the number of visits to the emergency department (ED) in the first year of life, according to a new study conducted in a large urban pediatric care practice that serves a low-income population with limited health literacy.

The 230 participants, caregivers of newborns visiting a pediatric clinic, were divided into 2 groups. One group received anticipatory guidance at all well-child visits along with information related to their child’s growth and development using Bright Futures handouts, as well as a condensed version (ESoC; enhanced standard of care) of these handouts designed to serve as a simplified guide. Caregivers assigned to the text-messaging group received, in addition to the ESoC documents, 4 educational messages per week until their child was aged 6 months. Content addressed nutrition, safety, feeding, and common concerns associated with ED visits, including fever, voiding and stooling, and skin issues.

Participants who did not receive text messages made a total of 240 ED visits in the first year of their child’s life whereas those who received texts made 168 such visits. Also, compared with those who received texts, participants who were given solely printed material were almost 1.5 times more likely to go to the ED for nonurgent visits in their child’s first 12 months. Further, a survey conducted at the end of the study showed that those in the text group liked receiving the messages (Ladley A, et al. Acad Pediatr. 2018;18[6]:636-641).

Thoughts from Dr. Burke

This is a great way to take advantage of technology that is in nearly every parent’s hand. The researchers showed decreased ED visits overall and, specifically, decreased ED utilization for nonurgent reasons. Using text messages in this way could also reduce the overall cost of medical care, ED wait times, and nosocomial infection spread in the ED waiting room. I’d be interested in knowing if the frequent texts also improved parents’ feelings of competence in caring for their babies and an increased sense of connection to their child’s medical home. This is an exciting idea. I hope that this practice becomes commonplace.