Inpatient Telepsychiatry —
An Interview with Jim Varrell, MD

Mental illnesses come in varying levels of severity. Inpatient units or facilities are short-term, crisis stabilization centers for people with acute mental and behavioral health conditions. Telepsychiatry, or the delivery of psychiatric care through secure videoconferencing, can be used in this setting to help create a safe environment during an individual’s most critical state of treatment. InSight Telepsychiatry’s Medical Director James Varrell, MD answers frequently asked questions about inpatient telepsychiatry.

How does inpatient telepsychiatry work?

A telepsychiatry provider’s role in an inpatient program works much in the same fashion as in any other mental and behavioral health setting. A telepsychiatry provider makes diagnoses, implements treatment plans and collaborates with an onsite team throughout a shift to discuss treatment, co-occurring medical needs and commitment or discharge plans. In an inpatient setting, individuals need to be seen by a psychiatry provider at least once every day usually during rounding.

All inpatient units will have in-person psychiatry providers as well as a consistent team of generally three to five telepsychiatry providers who collaborate and help deliver reliable psychiatric coverage to the unit around the clock. Throughout a shift, telepsychiatry providers work closely with an in-person facilitator who manages the flow of patients into a dedicated space with televideo and acts as the remote provider’s onsite eyes, ears and nose when needed. A computer or tablet can also be brought into rooms of patients who are acute or not able or able to leave their rooms in order to meet with the psychiatry provider.

If a telepsychiatry provider is offering weekday coverage, that day typically includes morning meetings with staff, admissions, check-ins and discharges. Telepsychiatry providers are trained to know the local resources and outpatient options for patients and will also work closely with onsite staff to make the best discharge plans. As telepsychiatry providers settle in to the unit, many report feeling as though the remote unit is in their own neighborhood as they are so familiar with available referral options.

Weekend rounding typically includes admissions, check-ins and morning meetings, which may include patient handoffs from other psychiatrists or nurse practitioners. Most hospitals don’t discharge on a weekend because referral resources tend to only be in operation Monday through Friday. Doing so ensures patients receive care and limits risks for all parties.

How does observation on the floor happen via telehealth?

Telepsychiatry providers are trained to work closely with in-person health care professionals on their team to be their extender on the floor. Telepsychiatry is no different from in-person care in that you have to consult with a team of nurses, social workers, activity therapists and others about the status of patients. Some units can get creative and use a mobile technology unit that would allow a telepsychiatry provider to explore the unit more literally, but in my experience with in-person inpatient care, psychiatrists generally spend most of their day in their office seeing each patient in turn anyway, so the remote experience is not too different.

Do acute patients react well to telepsychiatry?

In my experience, getting patients and facilitators comfortable with telepsychiatry doesn’t take much, even in an inpatient setting. Telepsychiatry can be less threatening for patients with paranoia than in-person care because it removes the risk of physical violence and allows a patient to walk out of the room or turn off the TV if they have the need to escape.

Though the question seems to always come up, there have only been a handful of cases in my 18 years of telepsychiatry experience when a patient couldn’t be seen or supported by telepsychiatry because they believed I was a television or movie character talking to them.

If a patient is being resistant, another option is for a facilitator to ask the patient questions in front of a camera while the telepsychiatry provider observes quietly.

How does documentation work?

Telepsychiatry providers are generally set up with remote access to a program’s existing electronic medical record meaning that remote providers are able to document just like in-person psychiatry providers do.

As a provider, what are the benefits of working in inpatient telepsychiatry?

Telepsychiatry in general is a lifestyle choice with benefits including no commute, schedule flexibility and the ability to work from home.

There is a lot of flexibility when practicing in an inpatient unit from home using telepsychiatry. You typically don’t have to work the same set schedule every day, which allows you to build a unique schedule around your ideal lifestyle. Providers can also build a community with the onsite staff who is available to debrief on interesting or difficult patients, check a patient’s chart and answer questions. Collaborating with onsite staff helps build rapport and establish a routine around providing quality care to patients that is centered on relationships.

At InSight specifically, inpatient telepsychiatry providers are offered stability and benefits including health insurance, malpractice insurance, 401k options, expense accounts, paid licensing and credentialing fees, technology and more. InSight prides itself on giving its providers unmatched administrative, clinical, technical and engagement support.

Inpatient telepsychiatry is a great starting point for someone starting a career in telepsychiatry because credentialing with one facility is much faster than credentialing with multiple ones. Using inpatient telepsychiatry for moonlighting can also be a great introduction to telepsychiatry that enables providers to earn guaranteed compensation while working towards other opportunities.

 

As a provider who has been practicing telepsychiatry for 18 years, why do you choose to provide inpatient care?

Some providers are hesitant about working in inpatient care, but to me, psychiatry is psychiatry. In every mental health care setting, providers have to decide a patient’s risk level and their treatment options. Inpatient telepsychiatry may not be for everyone, but I personally really enjoy working in this setting and getting to build long term relationships with the onsite staff in the units that I serve. Like all forms of telepsychiatry, inpatient telepsychiatry presents opportunities to help people in underserved areas during times of great need and lead them towards a path of better wellness. With inpatient telepsychiatry, I like to focus on where the patient is now and how we can set them on the right path of treatment.

 

 

To learn more about inpatient telepsychiatry employment options, please visit InSight Telepsychiatry’s Clinical Opportunities page.