Implementation and Evaluation of a Virtual Transitional Care Intervention Using Automated Text Messaging and Virtual Visits After Emergency Department Discharges: Retrospective Cohort Study

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