Telemental Health Evaluations Enhance Access and Efficiency in a Critical Access Hospital Emergency Department

Abstract

Telemedicine appears to be an effective intervention for mentally ill patients by providing more timely access to mental health evaluations in rural hospital emergency departments.

Telehealth Increases Access to Care for Children Dealing with Suicidality, Depression, and Anxiety in Rural Emergency Departments

“…This approach was preferred by the reviewing IRB, so that all children had access to specialist-based psych care in the rural CAHs, due to the urgent MH needs of participating communities that had been observed in prior studies. 12,16,19 While the authors believe that it is important to note and discuss the emerging trends for school-age children in this regional study, the results of this study are not necessarily generalizable to other regions or groups of rural hospitals.…”

“…[4][5][6][7][8] According to experts, ready access to the LVI method of telemental health care delivery in the ED supports numerous benefits to patients, families, providers, and health systems, including decreased wait/transfer times in the ED, 9,12,13 decreased length of stay (LOS), 9,[14][15][16] enhanced quality of care and care coordination, [7][8][9][14][15][16] enhanced ''learning effect'' for the generalist health care providers collaborating with psych specialty providers via telehealth, 9,[12][13][14]17 enhanced connection to outpatient (OP) resources, [14][15][16] cost savings due to reduced number of hospital admissions, [14][15][16] and decreased travel costs for families and MH professionals. [14][15][16] Evaluating telemental health care processes is important to meet or exceed standards of care. [5][6][7][8][9][10][11] Telehealth provides ready access to MH care in underserved areas, thus potentially ''leveling the playing field'' for participating rural ED patients and providers by mitigating the social determinants of health that often underlie rural health disparities.…”

“…Based on previous research studies, 12,16 increasing numbers of the targeted region's patients are self-reporting the need for MH care when they present to the participating rural EDs. However, waits for psychiatric visits can take weeks or even months in this particular region, due to the shortage of child and adult psychiatrists in these rural counties.…”

“…The mean total payor reimbursement amounts for pediatric MH patients in the ED were significantly lower than the actual ED costs, whether the subsequent patient discharge plan was IP [$3,665, 95% CI: ($364-$6,965)] or OP [$710, 95% CI: ($406-$1,013)] p < 0.001, respectively. Overall, percent re-imbursement based on payor differed significantly, and ranged from 19% [95% CI: [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] in the case of OP discharge from the ED to 42% [95% CI: 9-75; p = 0.007] for children subsequently admitted to IP care. Percent reimbursement from Medicaid was significantly lower than private payors for both types of cases, that is, patients who were discharged to IP [95% CI: 18%[(-)44-79] vs. 66% (41-92)] and patients who were discharged to OP [95% CI: 7% (5-9) vs. 51% (37-65); p < 0.001, respectively].…”

Service providers’ experiences of using a telehealth network 12 months after digitisation of a large Australian rural mental health service

“…Telehealth is a means of providing healthcare that overcomes physical distance barriers to accessing mental health care services for patients in non-metropolitan areas, thereby potentially reducing disparities in service delivery between urban and rural communities [2] and reducing costs to the health system and consumers by avoiding unnecessary hospitalisations and travel [3]. Mental health care via telehealth can cover service gaps (eg lack of psychiatrists in rural areas), provide urgent services (including pre-admission consultations), more timely access in rural emergency departments, mandated services such as healthcare in prisons, and expansion of multisite clinical discussions [3,4,5,6]. 'Store and forward' telehealth with language translation services also makes possible improved access to culturally relevant mental health care [7].…”