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Analysis

Expansion of Emergency Department Telepsychiatry Urged

By Christopher Cheney  
   June 22, 2018

With an increasing volume of mental health visits at emergency rooms, telemedicine has the potential to improve clinical care and ER operations.

Researchers are calling for the expansion of telepsychiatry services in the country's emergency departments (EDs).

In an article published this month in the American Journal of Emergency Medicine, the researchers found multiple benefits from ED telepsychiatry.

"The development of novel patient platforms such as telemedicine may offer an innovative approach to mental health care in the ED that may optimize and improve patient outcomes while also helping to reduce challenges such as ED overcrowding and limited specialist availability," the researchers wrote.

Earlier research has shown a pressing need to boost mental health services in emergency rooms. One study showed that 1 out of 8 ED visits involves mental health as the chief complaint.

There are two main clinical benefits from enhancing ED mental health services, the corresponding author of the American Journal of Emergency Medicine research, Bernard Chang, MD, PhD, told HealthLeaders this week:

  • The ED allows clinicians to intervene in the ultra-acute setting, when a psychiatric event has occurred or is at greatest risk of occurring
     
  • The ED can help offer seamless integration with behavioral health specialists that patients may otherwise have challenges coordinating on their own

Anxiety and depression appear to be particularly well-suited for ED telepsychiatry, Chang says. "Many of the assessments and treatments can be done remotely."

He says telepsychiatry can spare anxiety and depression patients the stress associated with busy EDs. "The acute care environment may sometime exacerbate psych complaints. So, the less time patients can be in that chaotic environment, the better, particularly those with anxiety or depression."

Several healthcare organizations have published positive results from using a telemedicine platform for psychiatry, Chang and his coauthor wrote. In addition to treating depression and anxiety, those programs reported success in cognitive behavior therapy as well as supportive therapy for PTSD patients.

Telemedicine programs such as telestroke care have been adopted at many EDs, but ED telepsychiatry is relatively rare. Financial factors are among the obstacles, the American Journal of Emergency Medicine researchers wrote.

"In a survey of several ED telepsychiatry programs, researchers found that key challenges included financial sustainability of such programs ranging from initial upfront startup costs to ongoing carrying costs associated with maintaining such a program."

Despite the challenges, the potential benefits of ED telepsychiatry are significant, the researchers wrote.

"ED overcrowding has been associated with multiple negative outcomes from patient satisfaction, medical errors, and patient perceptions of clinician communication. ED telepsychiatry may help offset patient burden in the ED and improve overall length of stay and patient satisfaction."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

1 out of 8 ER visits involve mental health as the chief complaint

Anxiety and depression are among conditions well-suited for telepsychiatry

Financing is a key challenge for ER telepsychiatry programs


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