Comparable reliability and acceptability of telepsychiatry and face-to-face psychiatric assessments in the emergency room setting

Bistre, Moises; Juven‐Wetzler, Alzbeta; Argo, Daniel; Barash, Igor; Katz, Grégory; Teplitz, Ronen; Said, M.-M.; Kohn, Yoav; Linkovski, Omer; Eitan, Renana

doi:10.1080/13651501.2021.1979586

Cited by 9 publications

(19 citation statements)

References 34 publications

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“…Twenty-six of the 46 articles reported on strategies that encompassed all mental illness presentations to the ED ( Table 4 ). The 11 types of strategies implemented in ED included decision support tools [e.g., modifications to electronic medical record (EMR)] ( 62 , 63 , 67 , 79 ), discharge and transfer of care (e.g., collaboration and communication processes) ( 62 , 63 , 81 ), liaison psychiatry services (e.g., included ED staff in meetings) ( 63 ), telepsychiatry (e.g., assessment) ( 64 , 82 ), changes to roles and rostering (e.g., mental health professions in ED) ( 63 , 65 , 69 , 73 , 78 , 80 , 83 ), specialised units within ED (e.g., behavioural assessment unit) ( 66 , 72 , 75 , 76 , 85 , 86 ), education and training (e.g., related to mental illness) ( 68 ), intervention teams (e.g., multidisciplinary team) ( 70 , 84 ), standardising protocols (e.g., procedures for agitated behaviour management) ( 71 , 78 , 79 , 86 , 87 ), environmental design (e.g., glass doors) ( 74 ), and case management (e.g., facilitating connections with services) ( 77 , 86 ). System performance effects (e.g., ED LoS and use of restraint) were reported for all 11 strategies, 7 strategies reported patient outcomes (e.g., ED utilisation), 6 strategies reported patient experience (e.g., preferences), and 8 strategies reported staff experience (e.g., confidence).…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen of the 26 articles included an academic medical centre ( 63 , 65 , 66 , 68 , 70 , 74 , 76 , 77 , 79 , 83 – 87 ), and 3 of the 26 included a community hospital ( 62 , 69 , 73 ). Nine of the 26 studies did not report the type of participating hospital ( 64 , 67 , 71 , 72 , 75 , 78 , 80 – 82 ). Eighteen of the 26 articles were conducted in urban settings ( 63 , 65 , 66 , 68 – 70 , 72 , 75 – 77 , 79 – 81 , 83 – 87 ), with one reporting an additional rural site ( 84 ), and two reported only rural sites ( 73 , 82 ).…”

Section: Resultsmentioning

confidence: 99%

“…Eighteen of the 26 articles were conducted in urban settings ( 63 , 65 , 66 , 68 – 70 , 72 , 75 – 77 , 79 – 81 , 83 – 87 ), with one reporting an additional rural site ( 84 ), and two reported only rural sites ( 73 , 82 ). Five of the 26 studies did not report the setting as either urban or rural ( 62 , 64 , 67 , 71 , 74 , 78 ). Thirteen articles reported that the participating EDs were connected with psychiatric crisis services ( 62 , 69 – 71 , 74 – 76 , 78 , 79 , 82 , 85 – 87 ), and 13 did not ( 20 , 63 – 68 , 72 , 73 , 77 , 80 , 81 , 83 ).…”

Section: Resultsmentioning

confidence: 99%

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Improving emergency department care for adults presenting with mental illness: a systematic review of strategies and their impact on outcomes, experience, and performance

Austin,

Cheek,

Richardson

et al. 2024

Front. Psychiatry

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BackgroundCare delivery for the increasing number of people presenting at hospital emergency departments (EDs) with mental illness is a challenging issue. This review aimed to synthesise the research evidence associated with strategies used to improve ED care delivery outcomes, experience, and performance for adults presenting with mental illness.MethodWe systematically reviewed the evidence regarding the effects of ED-based interventions for mental illness on patient outcomes, patient experience, and system performance, using a comprehensive search strategy designed to identify published empirical studies. Systematic searches in Scopus, Ovid Embase, CINAHL, and Medline were conducted in September 2023 (from inception; review protocol was prospectively registered in Prospero CRD42023466062). Eligibility criteria were as follows: (1) primary research study, published in English; and (2) (a) reported an implemented model of care or system change within the hospital ED context, (b) focused on adult mental illness presentations, and (c) evaluated system performance, patient outcomes, patient experience, or staff experience. Pairs of reviewers independently assessed study titles, abstracts, and full texts according to pre-established inclusion criteria with discrepancies resolved by a third reviewer. Independent reviewers extracted data from the included papers using Covidence (2023), and the quality of included studies was assessed using the Joanna Briggs Institute suite of critical appraisal tools.ResultsA narrative synthesis was performed on the included 46 studies, comprising pre-post (n = 23), quasi-experimental (n = 6), descriptive (n = 6), randomised controlled trial (RCT; n = 3), cohort (n = 2), cross-sectional (n = 2), qualitative (n = 2), realist evaluation (n = 1), and time series analysis studies (n = 1). Eleven articles focused on presentations related to substance use disorder presentation, 9 focused on suicide and deliberate self-harm presentations, and 26 reported mental illness presentations in general. Strategies reported include models of care (e.g., ED-initiated Medications for Opioid Use Disorder, ED-initiated social support, and deliberate self-harm), decision support tools, discharge and transfer refinements, case management, adjustments to liaison psychiatry services, telepsychiatry, changes to roles and rostering, environmental changes (e.g., specialised units within the ED), education, creation of multidisciplinary teams, and care standardisations. System performance measures were reported in 33 studies (72%), with fewer studies reporting measures of patient outcomes (n = 19, 41%), patient experience (n = 10, 22%), or staff experience (n = 14, 30%). Few interventions reported outcomes across all four domains. Heterogeneity in study samples, strategies, and evaluated outcomes makes adopting existing strategies challenging.ConclusionCare for mental illness is complex, particularly in the emergency setting. Strategies to provide care must align ED system goals with patient goals and staff experience.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Improving emergency department care for adults presenting with mental illness: a systematic review of strategies and their impact on outcomes, experience, and performance

Austin,

Cheek,

Richardson

et al. 2024

Front. Psychiatry

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“…These studies have usually relied on either quantitative or qualitative methods. In addition, the studies generally focused on one type of telepsychiatry (such as telephone or video conferencing) within one service or department 14…”

Section: Introductionmentioning

confidence: 99%

Evaluation of telepsychiatry during the COVID-19 pandemic across service users, carers and clinicians: an international mixed-methods study

et al. 2023

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BackgroundWorldwide uptake of telepsychiatry accelerated during the COVID-19 pandemic.ObjectiveTo conduct an evaluation of the opinions, preferences and attitudes to telepsychiatry from service users, carers and clinicians in order to understand how telepsychiatry can be best used in the peri/post-COVID-19 era.MethodsThis mixed-methods, multicentre, international study of telepsychiatry was set in two sites in England and two in Italy. Survey questionnaires and focus group topic guides were co-produced for each participant group (service users, carers and clinicians).FindingsIn the UK, 906 service users, 117 carers and 483 clinicians, and in Italy, 164 service users, 56 carers and 72 clinicians completed the surveys. In all, 17 service users/carers and 14 clinicians participated in focus groups. Overall, telepsychiatry was seen as convenient in follow-ups with a specific purpose such as medication reviews; however, it was perceived as less effective for establishing a therapeutic relationship or for assessing acutely disturbed mental states. In contrast to clinicians, most service users and carers indicated that telepsychiatry had not improved during the COVID-19 pandemic. Most service users and carers reported that the choice of appointment modality was most often determined by the service or clinician.Conclusion and relevanceThere were circumstances in which telepsychiatry was seen as more suitable than others and clear differences in clinician, carer and service user perspectives on telepsychiatry.Clinical implicationsAll stakeholders should be actively engaged in determining a hybrid model of care according to clinical features and service user and carer preferences. Clinicians should be engaged in training programmes on telepsychiatry.

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“…All patients were evaluated both face to face and by video link by 2 different clinicians. The main finding was that there was an extremely high degree of concordance between impressions arrived at under the 2 conditions, especially regarding the need for involuntary admission [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Enabling Expedited Disposition of Emergencies Using Telepsychiatry in Israel: Protocol for a Hybrid Implementation Study

Shalev,

Bistre,

Lubin

et al. 2023

JMIR Res Protoc

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Background Telepsychiatry is the use of virtual communication, such as a video link, to deliver mental health assessment, treatment, and follow-up. Previous studies have shown telepsychiatry to be feasible, accurate compared with in-person practice, and satisfying for psychiatrists and patients. Telepsychiatry has also been associated with reduced waiting times for evaluation and, in some studies, lower admission rates. However, most previous studies focused on using telepsychiatry in community settings and not on involuntary admission. Objective The aim of this study is to examine the effectiveness and implementation process of patient assessment for involuntary admissions in the psychiatric emergency department (ED) using a video link. Methods This type 1 hybrid implementation study will examine telepsychiatry effectiveness and the implementation process, by comparing telepsychiatry (n=240) with historical controls who had a face-to-face evaluation (n=240) during the previous, usual care period in 5 psychiatric EDs in Israel. A temporary waiver of the standing policy requiring in-person evaluations only, for the purpose of research, was obtained from the Israeli Ministry of Health. During the telepsychiatry phase, clinical staff and patients will join a video call from the ED, while the attending physician will log in elsewhere. The Promoting Action on Research Implementation in Health Services (PARIHS) framework will guide the evaluation of the telepsychiatry implementation process in the ED. PARIHS has the following 3 constructs: (1) evidence: staff's opinions regarding the innovation’s viability and practicality, their satisfaction levels with its use, and patients' perceptions of the change; (2) context: level of approval of new strategies in the ED, decision-making processes, and the manner in which clinical teams converse and work together; (3) facilitation: adequacy of the facilitation efforts using champions reports. Primary clinical outcomes include ED length of stay and violent incidents obtained from medical records. Results This study received Helsinki approval from the Ethics Committee of Abarbanel Mental Health Center (174; March 13, 2023), Jerusalem Mental Health Center (22-21; November 6, 2022), Lev-Hasharon Mental Health Medical Center (LH12023; February 12, 2023), Tel-Aviv Medical Center (TLV-22-0656; January 3, 2023), and Sha'ar Menashe (1-4-23; April 18, 2023). Data collection began in July 2023 in 2 study sites and will begin soon at the others. Conclusions Telepsychiatry could have significant benefits for patients in the psychiatric ED. Examining telepsychiatry effectiveness in the ED, in addition to identifying the facilitators and barriers of implementing it in different emergency settings, will facilitate better policy decisions regarding its implementation. Trial Registration ClinicalTrials.gov NCT05771545; https://clinicaltrials.gov/study/NCT05771545 International Registered Report Identifier (IRRID) DERR1-10.2196/49405

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Comparable reliability and acceptability of telepsychiatry and face-to-face psychiatric assessments in the emergency room setting

Cited by 9 publications

References 34 publications

Improving emergency department care for adults presenting with mental illness: a systematic review of strategies and their impact on outcomes, experience, and performance

Improving emergency department care for adults presenting with mental illness: a systematic review of strategies and their impact on outcomes, experience, and performance

Evaluation of telepsychiatry during the COVID-19 pandemic across service users, carers and clinicians: an international mixed-methods study

Enabling Expedited Disposition of Emergencies Using Telepsychiatry in Israel: Protocol for a Hybrid Implementation Study

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