• Chien-Hsin Lu, Yuh-Shin Kuo, Jing-Shia Tang, and Chih-Hao Lin.
• Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Shengli Rd., North District, Tainan City 70403, Taiwan.
• Am J Emerg Med. 2025 Jan 27; 90: 192199192-199.

BackgroundHealthcare discharge instructions are important for patients who are discharged from the emergency department (ED).ObjectiveThis study aimed to evaluate the use of short message services (SMSs) for patient instruction on healthcare knowledge, care confidence, anxiety, and satisfaction in ED-discharged patients.MethodsA descriptive correlational study using an online questionnaire survey was conducted for ED-discharged patients with fever or symptoms of airway infection from August 1, 2021, to July 31, 2022. We utilized a questionnaire to evaluate the domains of healthcare knowledge, care confidence, anxiety, and satisfaction. Pearson correlations between variables were calculated. Independent samples t-tests and one-way ANOVA with post hoc tests were used to estimate least squares means for different age, sex, or education groups, and the mean differences in response scores were tested. Statistical significance was set at P < .05.ResultsA total of 618 validated questionnaires were included in the analysis. In the fever group (n = 238), anxiety was negatively correlated with care confidence and satisfaction (r = -0.213, P < .001; r = -0.189, P = .003, respectively). Knowledge was positively correlated with care confidence and satisfaction (r = 0.217, P < .001; r = 0.192, P = .002, respectively). Patients with higher education levels, compared with those with lower education levels, had greater knowledge (6.8 ± 0.4 vs. 6.5 ± 1.0, t = -3.323, P = .001), care confidence (27.8 ± 3.3 vs. 26.5 ± 4.2, t = -2.661, P = .008), and satisfaction (25.7 ± 2.9 vs. 24.3 ± 3.3, t = -3.558, P < .001). In the airway infection group (n = 380), anxiety was negatively correlated with care confidence (r = -0.209, P < .001) and satisfaction (r = -0.245, P = .003). Knowledge and care confidence were positively correlated with satisfaction (r = 0.193, P < .001; r = 0.649, P < .001, respectively). Compared with males, females had greater knowledge (9.6 ± 1.1 vs. 9.2 ± 1.3, t = 2.597, P = .010) and anxiety (10.0 ± 4.7 vs. 9.0 ± 4.3, t = 2.053, P = .041). Patients with higher education levels had greater knowledge (9.6 ± 0.9 vs. 9.2 ± 1.4, t = -3.473, P = .001), care confidence (28.1 ± 2.9 vs. 27.1 ± 3.4, t = -3.350, P = .001), and satisfaction (25.6 ± 3.2 vs. 24.4 ± 3.1, t = -3.751, P < .001).ConclusionsPatient who received SMS-based health discharge instructions improved knowledge, care confidence, and satisfaction after ED visits. Future research should explore the application of the system across a broader range of emergency medical conditions.Copyright © 2025 Elsevier Inc. All rights reserved.

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