Virtual Psychiatric Consultations Shorten ED Wait Times
Team uses videoconferencing to evaluate patients at 21 hospitals
A telepsychiatry program that provides virtual psychiatric consultations to patients in 21 EDs in the Carolinas HealthCare System has reduced the ED length of stay for patients with behavioral health issues who have typically spent long periods of time waiting for behavioral health treatment and placement.
“Our goal is to fill the gap between the time a patient’s need for behavioral health treatment is identified and the time the patient starts appropriate treatment. We know that the best place for patients with behavioral health issues is not sitting in the emergency department. We work with the emergency department team to begin care earlier, triage patients, and move them to the appropriate level of care,” says Amy Barrett, MA, LPC, manager of the telepsychiatry program.
ED physicians frequently lack the time, training, and resources to recognize and treat behavioral conditions, which often present as physical symptoms like insomnia or headaches, she adds.
“In addition, the emergency department nursing staff is always extremely busy. Creating a centralized team that can take over the task of evaluating patients and making psychiatric referrals is a huge win for everyone,” she says.
The Carolinas virtual behavioral health team includes licensed master’s-level clinicians and psychiatric nurses, and psychiatrists and nurse practitioners who provide the virtual and telephonic assessments. They work remotely and operate 24 hours a day, seven days a week. The team works 12-hour shifts and are staffed to demand. They follow escalation plans when there are surges in patient volume.
The program is available to 21 EDs in the Carolinas HealthCare System and provides more than 1,000 consultations each month, and daily rounding on patients waiting for psychiatric placement, Barrett reports.
Working with a technology company, the telepsych team created an electronic virtual tracking board to trace the progress of patients from the time they enter the system until they are placed in an appropriate level of care. Among the metrics tracked are the number of consults, response time, consult request to time the consult is completed, the time the consult is complete to discharge, and the time it takes to find an appropriate placement.
When ED patients at the participating hospitals are identified as having behavioral disorders, an ED physician electronically orders the telepsychiatry consult and enters the information into the tracking system. The staff at the referring hospital conduct medication reconciliation, routine labs, and physician/nursing documentation and enters the information in the electronic medical record where it is visible to the psych team, Barrett says.
The referring hospital performs an electronic ED behavioral health assessment to streamline and document patient needs. The ED staff conducts a urine drug screen and a blood alcohol level test on patients identified with behavioral issues. If a patient is intoxicated, the ED team postpones the evaluation until the patient is clinically sober.
When the telepsychiatry team receives a consult request, team members gather as much information as they can by interviewing the patient, the nurse at the referring facility, and family members. They collect details on the patient’s physical condition, behavioral health issues, and other clinical information the psychiatrist needs to develop a treatment plan.
The licensed telepsychiatry clinician conducts a phone assessment of the patient and documents the clinical information. The assessment includes questions of why the patient came to the hospital, sleeping habits, appetite, prior treatment, acuity, dangerousness, and social questions such as living situation and support, Barrett says.
When all of the pertinent clinical information gathered is documented in the patient record, the clinicians change the color of the tracking board icon to notify the psychiatrist the patient is ready for a psychiatric consultation. Using videoconferencing equipment, the psychiatrist talks with the patient and family.
When it’s time for the psychiatric consultation, the ED staff puts patients in a private room and rolls in a cart with videoconferencing equipment. The psychiatrist conducts the consultation with a nurse in the room. The psychiatrist enters recommendations into the medical record, where it is available to the ED staff.
“Our goal is to get the patients to the appropriate level of care in less than 20 hours. We are working to overcome transportation issues, legal paperwork, and defects that delay the process,” Barrett says.
Approximately 35% to 40% of patients who receive virtual behavioral health services are discharged. The rest go through the behavioral health placement process, Barrett says.
A virtual patient placement team searches for available and clinically appropriate beds and coordinates the patient transfers. “We round daily on all the patients waiting for appropriate placement. During rounds, we talk to the nurse and to the patient,” Barrett says. “When patients improve, we evaluate them and discharge them to home. Then the behavioral health team contacts them daily,” Barrett says.
In the past, multiple hospitals were competing for the same beds, and busy ED nurses were tasked with finding psychiatric placements. “Historically, patients with psychiatric needs were cleared medically, then transferred to the behavioral health emergency department, where they often had to wait for days for a bed. The behavioral health emergency department is often on diversion due to high patient volumes overflowing. These patients already are in a safe place, with medical staff and, through telepsych, get the care they need in a timely manner,” she says.
A telepsychiatry program that provides virtual psychiatric consultations to patients in 21 EDs in the Carolinas HealthCare System has reduced the ED length of stay for patients with behavioral health issues who have typically spent long periods of time waiting for behavioral health treatment and placement.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.