Next Generation Model for Addressing Crisis Behavioral Health in the ED

By: Geoffrey Boyce

Originally posted on The Healthcare Guys

The telemedicine revolution touches nearly every aspect of health care today. Notably, behavioral health was called out in a recent Forbes article as the sector within the industry experiencing the greatest impact. And hospital emergency departments (EDs) are taking note.

In recent years, EDs have faced notable challenges meeting growing needs for mental and behavioral health services, particularly for crisis psychiatric care, amid severe professional shortages. The reality is that all U.S. states have unmet psychiatric needs, and 60 percent of U.S. counties lack a single psychiatrist.

Telepsychiatry—offered via videoconferencing models—has emerged as an effective resource for filling these gaps and improving patient triage, throughput and overall behavioral health outcomes in the ED. As adoption of these technology-enabled models increases, hospitals need to thoughtfully consider what it takes to build a successful, sustainable 24/7 telepsychiatry program to address this type of care. Best practices dictate the need for robust provider networks, administrative teams and support infrastructures to facilitate collaboration between all stakeholders.

Our telepsychiatry organization is addressing these needs through a browser-based platform that is designed to deliver telepsychiatry services around the clock, better positioning hospital EDs and other crisis settings to provide timelier psychiatric assessments and patient triage to the most appropriate level of care via technology-enabled care.

Telepsychiatry in the ED: Opportunities and Considerations

The telepsychiatry opportunity is not lost on today’s EDs, and many hospitals are looking to incorporate these care options into their broader telehealth strategy. Use of telehealth promotes better patient outcomes and satisfaction, and lowers costs associated with ED boarding of psych patients. Yet, health care organizations must consider key elements of a strategy to extract the full value of these models, including technology and workflow design and a framework that supports comprehensive care delivery from the start.

For instance, one of the primary goals of a telepsychiatry program is to shorten wait times for evaluation. Many hospitals do not have an around the clock, full-time psychiatrist and must find available providers on an “as needed” basis to complete evaluations—an approach that often lends to protracted wait times, especially since most patients who come into the ED in crisis arrive during night and weekend hours.

While on-demand telepsychiatry provider networks are uniquely suited to address this challenge, the right infrastructure must also be in place to support the scheduling complexities of offering 24/7 telepsychiatry access to a busy ED.

Cloud-based applications can help to address this challenge and increase efficiency. ED staff can simply log into a platform and fill out a request for telepsychiatry services. Then, an automated system can identify the most appropriate telepsychiatry provider to do the assessment, consult or follow-up, taking into consideration which telepsychiatry providers are credentialed at the organization, on shift and available. Working directly within the hospital’s EMR, the assigned provider can then review patient background information and connect with hospital staff to determine any other relevant collateral information that may be necessary before the secure video connection with the patient is initiated. When all videoconferencing sessions and documentation are routed through a singular system, it decreases the potential for bottlenecks and allows for each session to be logged and reported on.

Data from our services revealed that patients receiving on-demand telepsychiatry services for crisis encounters in the ED waited just under an hour on average. This is an improvement over the findings of another report that revealed 23 percent of psychiatric patients wait longer than six hours for in-person evaluation in the ED, and 7 percent wait more than 12 hours.

Performance metrics for telepsychiatry programs should also point to reduced costs and better outcomes. Partnering with an on-demand telepsychiatry provider enables EDs to reduce length of stay, improve throughput, minimize risk and stress for onsite providers, and ultimately get patients to the least restrictive and most appropriate level of care quickly. Patients benefit from on-demand telepsychiatry by receiving timelier evaluations, minimizing the potential for further escalation. When patients in psychiatric crisis are not triaged quickly, conditions can quickly spiral out of control, opening the door to safety issues and the potential need for higher-cost interventions.

Additional data from our organization points to notable improvements in outcomes and the level of care required following a telepsychiatry visit. For example, in 2017, one-third of patients in Florida who had been involuntarily committed under their state law called the Baker Act had their commitments rescinded after meeting with a telepsychiatry provider. This allowed the patients to move to a more appropriate and less costly level of care, saving resources across the board.

Building a Robust, Impactful Telepsychiatry Operation

EDs are seeing an uptick in psychiatric cases due to the limited options of specialized providers in the community. Current estimates suggest that one in eight ED visits involve a behavioral health condition.

Forward looking health care organizations recognize the advantages of telepsychiatry models and are expanding their telemedicine portfolio to more fully address growing needs both within the ED setting and in community-based settings. Sustainable strategies consider the value of industry partnerships and third-party expertise, especially as it relates to building provider networks and utilizing infrastructures that optimize efficiency and support collaboration between administrators and specialty provider groups.

At their foundation, successful telepsychiatry programs are supported by strategic partnerships, robust provider networks and infrastructures that address scheduling, workflows and logistics. These underlying tactics must work in tandem to promote better care delivery, efficiency and connected care teams.