Journal article
Telepsychiatry services across an emergency department network: A mixed methods study of the implementation process
The American journal of emergency medicine, Vol.59, pp.79-84
09/2022
DOI: 10.1016/j.ajem.2022.06.053
PMID: 35810736
Abstract
Due to limited community resources for mental health and long travel distances, emergency departments (EDs) serve as the safety net for many rural residents facing crisis mental health care. In 2019, The Leona M. and Harry B. Helmsley Charitable Trust funded a project to establish and implement an ED-based telepsychiatry service for patients with mental health issues in underserved areas. The purpose of this study was to evaluate the implementation of this novel ED-based telepsychiatry service.
This was a mixed-methods study evaluating the new ED-based telepsychiatry consult service implemented in five EDs across three rural states that participated within a mature hub-and-spoke telemedicine network between June 2019 and December 2020. Quantitative evaluation in this study included characteristics of the telehealth encounters and the patient population for whom this service was used. For qualitative assessments, we identified key themes from interviews with key informants at the ED spokes to assess overall facilitators, barriers, and impact. Integrating the quantitative and qualitative findings, we explored emergent phenomena and identified insights to provide a comprehensive perspective of the implementation process.
There were 4130 encounters for 3932 patients from the EDs during the evaluation period. Approximately 54% of encounters involved female patients. The majority of patients seen were white (51%) or Native American (44%) reflecting the population of the communities where the EDs were located. Among the indications for the telepsychiatry consult, the most frequently identified were depression (28%), suicide/self-harm (17%), and schizophrenia (12%). Across sites, 99% of clinician-to-clinician consults were by phone, and 99% of clinical assessments/evaluations were by video. The distribution of encounters varied by the day of the week and the time of day. Facilitators for the service included increasing need, a supportive infrastructure, a straightforward process, familiarity with telemedicine, and a collaborative relationship. Barriers identified by respondents at the sites included the lack of clarity of process and technical limitations. The themes emerging from the impact of the telepsychiatry consultation in the ED included workforce improvement, care improvement, patient satisfaction, cost-benefit, facilitating COVID care, and access improvement.
Implementation of a telepsychiatry service in ED settings may be beneficial to the patient, local ED, and the underserved community. In this study, we found that implementing this service alleviated the burden of care during the COVID-19 pandemic, enhanced local site capability, and improved local ability to provide quality and effective care.
•EDs serve as a safety net for rural residents facing crisis mental health care.•Telepsychiatry facilitators include a supportive infrastructure and a straightforward process.•Telepsychiatry challenges include the clarity of process and technical limitations.•Telepsychiatry impact in the ED include improvement in workforce and care.•Implementation in the ED helped local sites with burden of care during the COVID-19 pandemic.
Details
- Title: Subtitle
- Telepsychiatry services across an emergency department network: A mixed methods study of the implementation process
- Creators
- J. Priyanka Vakkalanka - Roy J. and Lucille A. Carver College of MedicineM. Muska Nataliansyah - Medical College of WisconsinKimberly A.S. Merchant - University of IowaLuke J. Mack - University of South DakotaSeth ParsonsNicholas M. Mohr - University of IowaMarcia M. Ward - University of Iowa
- Resource Type
- Journal article
- Publication Details
- The American journal of emergency medicine, Vol.59, pp.79-84
- DOI
- 10.1016/j.ajem.2022.06.053
- PMID
- 35810736
- NLM abbreviation
- Am J Emerg Med
- ISSN
- 0735-6757
- eISSN
- 1532-8171
- Publisher
- Elsevier Inc
- Grant note
- DOI: 10.13039/100007028, name: Leona M. and Harry B. Helmsley Charitable Trust
- Language
- English
- Date published
- 09/2022
- Academic Unit
- Rural Telehealth Research Center; Health Management and Policy; Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984281656302771
Metrics
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