Beam Me Out: Review of Emergency Department Telepsychiatry and Lessons Learned During COVID-19

Abstract

Purpose of ReviewThe aim of this review is to critically evaluate recent literature on the use of telepsychiatry in emergency departments (EDTP) and synthesize the evidence on telepsychiatry during public health emergencies. We also report on experiences and success stories from a state-wide EDTP program in South Carolina during the COVID-19 pandemic. Recent Findings We identified 12 peer-reviewed articles published between January 2019 and February 2021 that evaluated EDTP interventions and their impact on patient outcomes. The recent evidence on EDTP shows a significant association between EDTP implementation or use and decreased patients' wait time in emergency department (ED), shorter length of stay in certain settings, reduced ED revisit rates, improved ED patient disposition (e.g., more discharge to home, less observational stays, and decreased inpatient admissions), and reduced follow-up encounters involving self-harm diagnosis. Summary The EDTP virtual delivery model can help healthcare systems reduce burden of public health emergencies on providers, staff, and patients alike. While a disruption of magnitude seen by COVID-19 may be infrequent, strategies used during the pandemic may be implemented to enhance care in rural settings, and/or enhance preparedness of communities and healthcare systems during more commonly occurring natural disasters.

Virtual Specialist Care During the COVID-19 Pandemic: Multimethod Patient Experience Study

“…There is an increasing number of publications on the virtual experiences of patients, most of which have been conducted in singular fields such as oncology, pre- and postnatal care, and psychiatric care [ 15 - 20 ]. Similar to our findings, in the existing literature, there appears to be a consensus that virtual care is a satisfying alternative to in-person care, with benefits such as reduced travel, cost, time, and infectious exposure, and increased convenience [ 15 - 20 ]. Our analysis further revealed that the specific reason for the visit, and the nature and status of the medical condition are important considerations in terms of guidance on where virtual care is most effective.…”

Epidemiology of pediatric hospitalizations at general hospitals and freestanding children's hospitals in the United States: 2019 update

“…[31][32][33] These findings underscore the potential value of between-hospital partnerships and expanded telehealth initiatives to optimize mental healthcare delivery, particularly at hospitals with lower volumes. 34,35 This analysis also illustrates that one-third of all hospitalizations in 2019 were in children with complex chronic disease diagnoses and 55% of these hospitalizations occurred at GH. Children with medical complexity (CMC) are well-recognized as a vulnerable population at increased risk of hospitalization, in-hospital mortality, and hospital readmission.…”

“…Relatively low reimbursement for mental health hospitalizations, coupled with mental health professional shortages, may be barriers to hospitals' investment in mental health clinicians and other resources that improve the care of this population 31–33 . These findings underscore the potential value of between‐hospital partnerships and expanded telehealth initiatives to optimize mental healthcare delivery, particularly at hospitals with lower volumes 34,35 …”

Identifying unique barriers to implementing rural emergency department-based peer services for opioid use disorder through qualitative comparison with urban sites

“…The data do not provide an exact reason for these restricted hours, but rural vendors did have smaller budgets that prevented hiring peers to provide more extensive coverage and scheduling peer shifts during normal business hours was likely to attract more potential hires in rural areas where the applicant pool was likely smaller. One potential solution to low patient volume and incompatible staffing coverage would be to partner with an external peer telehealth hub that operates 24 h a day, as use of telehealth for substance use disorder and specialist services in the ED is becoming more common [ 32 , 33 ].…”