Most ERs do not have a psychiatrist on staff, and yet one-eighth of all hospital emergency visits require mental health diagnoses. Most emergency rooms are set up to deal with physical emergencies, traumatic injuries, and acute conditions. They’re not so ready to deal with psychiatric emergencies such as bipolar or schizophrenic episodes, although these cases are finding their way into emergency departments across the nation in record numbers. Many emergency rooms don’t have a psychiatrist on staff, let alone a mental health professional manning the ER around the clock. The solution is telepsychiatry: patch in qualified mental health providers remotely via video.
Telepsychiatry in the Emergency Department
According to a report by the American College of Emergency Physicians, the trend toward outpatient care for psychiatric patients has led to an influx of psychiatric cases ending up in the ER. Most emergency doctors lack the specific training to provide the type of psychiatric care patients need when in the throes of an episode or other psychiatric event; evaluation of psych patients is limited by the physician’s training, which usually falls outside the mental health discipline. With telemedicine, a qualified psychiatrist can meet with the patient virtually, assess his condition, consult with the ER doctor on call, make referrals, and more, all without being physically present in the ER.
The ACEP, in its Best Practices for Reducing ED Boarding of Psychiatric Patients guidelines, recommends the use of telemedicine when necessary to reduce patient boarding and inpatient admissions. Whereas traditional ER doctors may admit the psychiatric patient without a true and thorough assessment of his needs, having a psychiatrist present – if only virtually – can decrease admissions. In addition, consulting with a telepsychiatrist facilitates the start of the patient’s treatment regimen, accelerating outcomes.
The ACEP goes on to call telemedicine in psychiatry an “effective tool for evaluating the patient in an emergency setting.” A recent study published in the Journal of Telemedicine and Telecare found that in ERs where a facility psychiatrist was unavailable, telemedicine allowed ER staff to expedite the disposition of patients seeking psychiatric care.
A common practice in many ER departments is to hold psych patients until a consultation can be obtained. This not only delays the onset of proper evaluation and treatment for the patient, it also takes up valuable space needed by other patients in the ER while waiting for an on-call psychiatrist to make her way to the facility. With telespychiatry, patients get access to the care they need more quickly and have a reduced chance of being admitted to the hospital.
How Does Telepsychiatry Work?
Much like any other consultation, during a telepsychiatry consultation, the psychiatrist meets with her patient face to face via a webcam, usually attached to a telemedicine cart. The psychiatrist consults first with the ER doctor or other staff regarding the patient’s presentation and symptoms, noting observations that may be important in reaching a diagnosis and formulating a plan of treatment. The psychiatrist can then speak directly to the patient over high-quality video and using crisp audio. The cart generally allows for assessment of the patient (sometimes with the help of an assistant), including vitals, pulse, and more. Once patient assessment is complete, the psychiatrist can then devise a treatment plan and communicate with the attending physician to complete the consultation.
Setting up telepsychiatry in your ER is simple. Follow these steps:
- Set up a telepsych cart on wheels for easy mobility.
- The cart is battery-powered so you don’t have to plug it into the wall.
- The cart comes with a touch-screen computer for an easy user experience where a patient or nurse can log in to a virtual waiting room with one click.
- At the other end, the psychiatrist will view a dashboard that shows which patients are entering her queue.
- Above the computer screen is a camera that allows the psychiatrist to pan, tilt, and zoom remotely.
Of course, unlike other specialists, you don’t need a lot of medical device peripherals. You could easily get away with nothing more than a tablet like an iPad. Then you only need to train your staff to know when and how to call your telepsychiatrist via video. You’ll find that the burden of diagnosis shifts from overworked ER doctors to trained psychiatrists, making it a win-win for everyone.