Efficiency and acceptability of an electronic follow-up system (DayCOR) for paediatric patients

We note with interest the results of the survey by Smallbone et al., ¹ and write to provide additional support for their proposal that electronic follow-up is more efficient than telephone follow-up for clinical purposes.

We have been using an automated web-based system (DayCOR) which collects, alerts, manages and analyses patient-reported data (https://www.daycorregistry.com.au). DayCOR is used for post-discharge follow-up of day-procedure patients of all ages; the paediatric version is for patients aged ≤16 years. A link to the web-based questions is sent via SMS and email to the patient’s parent or carer approximately 24 hours after discharge, with a reminder at 48 hours. Parents/carers answer 15 clinical outcome, process and experience questions. Day surgery nurses call the parent/carer if requested.

The response rate for paediatric patients is 85.3% (852/999 patients to date, in two hospitals in Victoria and Queensland). Of the non-responders, 0.7% declined to complete the survey; the remainder allowed the survey links to expire. The questions were completed in approximately three minutes on average. Sending an email link as well as an SMS link to parents/carers increased the response rate by approximately 5%.

Approximately two-thirds of these patients underwent a dental or ear, nose and throat procedure. We found that 92.6% of patients were not prescribed antiemetics, and of these, 1.3% had significant post-discharge nausea or vomiting, as measured by a simplified postoperative nausea and vomiting impact scale. ² Forty-seven percent had a ‘worst pain score’ of ≥4 after discharge. Of these, 80.5% had been prescribed analgesics, and 16.5% were not improving by 24 hours postoperatively. A total of 2.5% of patients required ‘urgent post discharge medical assistance’; two-thirds of these (n = 14) used a phone call to the hospital, general practitioner or specialist. ‘Concerning behaviour’ was reported in 6.3% (n = 54) of children, which had not improved in 27.7% (n = 15) by 24 hours after discharge. A total of 94.6% were on track to return to school or other usual activities as planned.

In a study comparing the usual telephone call system and an electronic system (DayCOR) at one of the participating hospitals, we demonstrated significant benefits of the latter. ³ These included increased efficiency (a higher patient response rate, more complete data collection and lower cost) and increased acceptability to anaesthetists and day surgery nurses. We did not survey parents or carers, and therefore welcome Smallbone et al.’s finding of positive parental/carer attitudes towards using electronic devices and SMS messaging to follow up children after hospital discharge.