M5 Responses- ED Tele-Psychiatry Implementation Discussion
Overall, it appears that tele-psychiatry services offer a plethora of benefits. Bolle et al. (2017) found that the tele-psychiatry offered at their institution helped to reduce provider uncertainty regarding the diagnosis and the severity. Furthermore, it was helpful for medical providers who needed a specialist to confirm the admitting diagnosis (Bolle et al., 2017). These outcomes also benefitted the hospital and the patients as they allowed for improved care. The tele-psychiatry services also helped to build trust and alliances with the patients (Bolle et al., 2017). Again, this not only benefits the providers, but also the patients (Bolle et al., 2017).
Despite these benefits, there were challenges and barriers described in the case study. First, the medical staff members presented a barrier as the idea of implementing new technology was not initially well-received (Wager et al., 2017). Providers were concerned they would run into issues accessing the tele-psychiatry when needed or they could experience technology-related issues (Wager et al., 2017). Additionally, there were barriers related to finances and the current technology available (Wager et al., 2017).
Overall, it is unclear how well-equipped the Westend Hospital is to implement the new tele-psychiatry services. One advantage is that they already have an IT specialist ready to help with the transition (Wager et al., 2017). In general, the hospital will need to make sure that they have all the technology and hardware needed to support the audio and video applications. Of note, Bolle et al. (2017) found that oftentimes providers found that telephone calls were a sufficient mode of communication, and videoconferencing was not always needed. However, patients felt more confident in the decisions of their providers, which led to increased compliance, when videoconferencing was utilized (Bolle et al., 2017). This demonstrates the need for the service and hardware to support both audio and videoconferencing.
After the new tele-psychiatry services are implemented, Westend Hospital will need to measure the success of its program. The hospital could consider utilizing qualitative information like that used by Bolle et al. (2017). This could provide helpful information regarding staff and patient experiences and opinions. Another option is to compare how soon after admission a patient was ready for transfer before and after the tele-psychiatry services are implemented.
References
Bolle, S. R., Trondsen, M. V., Stensland, G. Y., & Tjora, A. (2017). Usefulness of videoconferencing in psychiatric emergencies — a qualitative study. Health and Technology, 8(1–2), 111–117. https://doi.org/10.1007/s12553-017-0189-z
Wager, K. A., Lee, F. W., & Glaser, J. P. (2017). Health care information systems: A practical approach for health care management (4th ed.). Jossey-Bass.
—————–POST 2———–Telepsychiatry was one of the first clinical uses of telemedicine and originally began as a service for rural regions where it was difficult to receive psychiatric care (Yellowlees et al., 2008). Recently, however, due to a shortage of mental health professionals and an increase in demand for mental health services, psychiatric care has become difficult for patients to access nationwide (Freeman, 2020). Due to the lack of available mental health services, patients experiencing mental health crises often must receive care in emergency departments (ED), which are commonly unequipped to handle most mental health emergencies, which can lead to improper diagnosis and treatment, prolonged hospital stays, and increased costs of care (Yellowlees et al., 2008). Hospitals also report these cases negatively affect the operation of the ED in terms of space, staffing, and resources, increasing the burden on patients, providers, and the health care system (Yellowlees et al., 2008).
Telepsychiatry has been suggested as a strategy to mitigate these issues. According to Natafgi et al. (2021), studies on ED-based telepsychiatry found services were associated with benefits including a reduced length of stay, a drop in inpatient admissions, increased cost-effectiveness, and improved satisfaction among patients and staff. Although, the implementation of telepsychiatry in an ED setting is not without its challenges. According to Yellowlees et al. (2008), obstacles can consist of up-front costs including the cost of personnel and equipment; gaining stakeholder buy-in; coordinating care between service lines; developing comprehensive protocols to ensure patient safety and quality of care; licensing and credentialing of providers; and reimbursement for services rendered from payers. Natafgi et al. (2021) also added the concern of protecting patient privacy while performing a telepsychiatry visit.
After reviewing the case scenario, it seems Westend Hospital is mostly equipped to implement telepsychiatry services. The resources Westend currently has in place include a contract with a telepsychiatry network that is cost-effective and has a history of positive patient outcomes; an implementation team to facilitate smooth execution of the system including the director of the telepsychiatry network, IT, and the leads of multiple other involved departments; the backing of executive leadership; the support of stakeholders; and the proper equipment to provide the service (Wager at al., 2017). The resources still needed may include the licensing and credentialing of the telepsychiatry providers within the hospital system and possibly across state lines; creating protocols for appropriate use of telepsychiatry and in-person consultation from psychiatry; delivering training to staff on the use of the system and equipment; and developing tools to evaluate how the telepsychiatry service is functioning. Some metrics that can be used to measure the effects of the telepsychiatry service include patient and provider satisfaction surveys, examining the cost-effectiveness of providing this service, and analyzing the data gathered on patients with mental health conditions visiting the ED including wait times, length of stay, admission rates, revisit rates, disposition status, and diagnoses at follow-up encounters (Natafgi et al., 2021).
Resources:
Freeman, R. E., Boggs, K. M., Zachrison, K. S., Freid, R. D., Sullivan, A. F., Espinola, J. A., & Camargo, C. A. (2020). National study of telepsychiatry use in U.S. emergency departments. Psychiatric Services, 71(6), 540–546. https://doi.org/10.1176/appi.ps.201900237 (Links to an external site.)
Natafgi, N., Childers, C., Pollak, A., Blackwell, S., Hardeman, S., Cooner, S., Bank, R., Ratliff, B., Gooch, V., Rogers, K., & Narasimhan, M. (2021). Beam me out: Review of emergency department telepsychiatry and lessons learned during COVID-19. Current Psychiatry Reports, 23(11), 72. https://doi.org/10.1007/s11920-021-01282-4 (Links to an external site.)
Wager, K. A., Lee, F. W., & Glaser, J. P. (2017). Health care information systems (4th ed.). John Wiley & Sons, Inc.
Yellowlees, P., Burke, M. M., Marks, S. L., Hilty, D. M., & Shore, J. H. (2008). Emergency telepsychiatry. Journal of Telemedicine & Telecare, 14(6), 277–281. https://doi.org/10.1258/jtt.2008.080419 (Links to an external site.)
