How do we change the paradigm from “admit the psychiatric patient” to “initiate psychiatric care promptly and decide on admission later”? Fortunately, there are effective, proven solutions now in operation around the country that can be implemented in any hospital or system, from remote departments that see only a handful of psychiatric patients a week to busy sites that might see a dozen or more psychiatric patients each day. Some options involve facilitating treatment quickly within the emergency department, while others involve alternate designs that can help prevent psychiatric emergency patients from ever coming to those departments in the first place.
Explore This IssueACEP Now: Vol 35 – No 07 – July 2016
The key to resolving psychiatric emergencies is getting patients evaluated by a psychiatrist and initiating treatment as soon as possible. With prompt intervention and the right strategies, the great majority of psychiatric emergencies can be resolved in fewer than 24 hours.
One drawback to on-demand telepsychiatry, and to telehealth in general, is that as with so many cutting-edge advancements, the technology is far ahead of the regulations.
For emergency departments with few psychiatric patient visits or limited resources, prompt intervention can be done in a cost-effective way via on-demand telepsychiatry. In this version of telehealth, a psychiatrist (who is often a specialist in emergency psychiatry) can be summoned promptly through videoconferencing to evaluate the patient and then recommend treatment and disposition options. Typically, a site will pay for such providers only when they need them. So if several days go by with no psychiatric patients, the hospital or emergency department doesn’t pay as it would have to for onsite or local on-call docs.
On-demand telepsychiatry has been proven to reduce psychiatric hospitalization rates and is associated with good outcomes and high patient satisfaction.5 It’s currently available in many states and will likely be an option soon in every state in the country.
One drawback to on-demand telepsychiatry, and to telehealth in general, is that as with so many cutting-edge advancements, the technology is far ahead of the regulations. Existing requirements that doctors be licensed in the state the patient is in limit the pool of available telepsychiatrists, especially in smaller-population states. In addition, contracting hospitals will still need each telepsychiatrist to be a fully credentialed, dues-paying member of their medical staff. As it can take as many as 15 to 20 telepsychiatrists to cover each hospital 24 hours a day, seven days a week, 365 days a year, this requirement can be very expensive and time-consuming.
Psychiatric Emergency Service
While ED on-demand telepsychiatry is a major improvement over the status quo, it still means the patient must spend time in the busy department, with loud noises such as beeps and sirens, flashing lights, people rushing about frantically, seeing and hearing others in severe pain, which can cause real distress. Such an environment is not conducive to mental health healing; on top of that, the logistics of emergency departments mean that, even with telepsychiatry, there usually isn’t an opportunity to initiate treatment and then observe the patient over time for improvement before making a disposition decision.