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Telepsychiatry and Its Effectiveness in the Emergency Department

Introduction

Methodology

Research Questions

Ethical Considerations

Limitations

Purpose of the Study

Literature Review

References

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The need for immediate and proper intervention during a mental health crisis is vital. Among many emergency departments the throughput of patients and the proper tools needed to adequately care for patient’s dealing with behavioral health issues is limited. Because of costs of hiring on campus psychiatrists is limited and the ratio of patient’s needing help to actual qualified providers is skewed, appropriate care is not rendered. in a timely manner, the need for proper attention for this patient population is hindered and often not efficient nor effective. Thus the need for immediate care for these patients is seen as a priority and the use of telepsychiatry may assist with this process.

This study identifies the lack of patient care when solely relying on face to face assessment of a clinical psychiatric provider.( Brenner, et al.,2020) The evaluation process, of having the patient wait hours and hours demonstrates the disservice and ineffectiveness of patient care for the behavioral health patient as they demonstrate unstableness and the inability to rationalize their emotions safely. Considerations of safety of staff, and the patients receiving care is evaluated. With the use of telepsychiatry and the proper implementation of the patient intake process the care of these patients is seen improved and efficiently effective.

1.) What are the age ranges being evaluated?

2.) Does gender affect the study in any way?

3.) Are there safety concerns to consider in conducting this study?

4.) Is the use of telepsychiatry cost effective?

5.) Are there ethical considerations that must be addressed?

6.) Is there specialized training that must be conducted to prepare staff for use of the telepsychiatry resource?

7.) Is there a consent for treatment being used?

Participants: In the proposal of, “use of telepsychiatry in the emergency department” the number of participants is listed as a total of 300 mixed ages, races, and gendered patients. The first 150 patients will be utilizing the resource of telepsychiatry. The second 150 patients will be observed with the same parameters as the listed above but instead of use of telepsychiatry they will be monitored and made to wait for face-to face interaction or assessed by a psychiatrist when available. Like the observed patients with the telepsychiatry services the face to face patients will be monitored the exact same with vitals taken, medically cleared, and the initial assessment of an Emergency physician and Registered nurse monitoring.

Materials: The use of a tele monitored contracted with a service to allow for private and safe patient evaluation services. The trained staff behavioral health nurse to assist in the service. The psychiatrist that is contracted to professionally and efficiently evaluate and treat the patient. (Reliford, & Adebanjo, 2019).

Procedure: The length of the study shall last no longer than and observed period of three months. In this three months the total amount of 300 patients will be monitored and observed while either utilizing the telepsychiatry service or the use of face to face method. (Reliford, & Adebanjo, 2019).

Design: The selected design for this study is observed, random sampling with the use of two way ANOVA primarily from the SPSS calculation service. The use of retrospective observation and comparison will also be utilized.

Prior to research shows that the care for those not receiving immediate psychiatric services in the emergency department with early intervention resulted in unstable and unsafe circumstances not only for the patient but for the staff, patient return of unresolved mental health problems/conditions, higher costs for hospitals, and overall safety concerns for physicians and staff. (Reinhardt, Gouzoulis-Mayfrank, & Zielasek, 2019)

Considerations of unstable patients without immediate care:

The patient may act irrational and leave before a proper evaluation and treatment is rendered due to long wait times. This is the most prevalent factor in not utilizing the telepsychiatry resource in the emergency department.(Brenner, et al., 2020) Research has shown that the lack of this resource allows for those patients needing immediate care to fall through the cracks and become a hazard to themselves as well as others.

The safety of all involved:

In the most research it shows that the need for immediate intervention for these patients allows for staff and security to mitigate and properly prepare for irrational behavioral outburst and/or concerns for safety. (Duerr, 2020) It is demonstrated that the Emergency department harbors many facets of medical emergencies, with that the lack of quick intervention qualified personnel allows for possible safety breach of staff and all other patients including the patient needing evaluation.

The observed and monitored limitations to the proposal of use of telepsychiatry in the emergency department are as follows:

1.) The availability of contracted psychiatrist to participate in the trial study and or service. A contract must be adhered to and followed.

2.) The staff must be trained in the implementation of this service. If they are not trained then inadequate patient care or facilitation of the resource occurs. (Mazhari, et al., 2019) Some facilities may lack the resources to provide proper and efficient training.

3.) Cost may be higher initially for licensure of service and/or resource. (Narasimhan & Colleagues, 2016 )

4.) The need for a longer period observed of patient behavior and outcomes.

Ethical Considerations are as follows:

1.) Patient Privacy and consideration of HIPPA (APA, 2017)

2.) The need for consent shall be disclosed and reviewed. This includes Informed, implied, expressed consent. (APA, 2017)

3.) Technical difficulties that may hinder the patient’s privacy such as loudness of the speaker and or other staff walking in and out of the room is seen as reviewed and shall be considered.

American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. Washington, DC. https://www.apa.org/ethics/code

Brenner, R., Madhusoodanan, S., Logiudice, J., Castell, G., MacKenzie, T., & O'Shaughnessy, P. M. (2020). A comparison study of the turnaround time for telepsychiatry versus face-to-face consultations in general hospital nonpsychiatric emergency rooms. Annals of clinical psychiatry: official journal of the American Academy of Clinical Psychiatrists, 32(1), 12–16

Duerr, H. A. (2020). The Future of Telepsychiatry. Psychiatric Times, 37(6), 18.

Mazhari, S., Nejad, A. G., Mofakhami, O., Raaii, F., & Bahaadinbeigy, K. (2019). Evaluating the Diagnostic Agreement between Telepsychiatry Assessment and Face-to-Face Visit: A Preliminary Study. Iranian Journal of Psychiatry, 14(3), 236–241.

New Telemedicine Study Findings Have Been Reported by M. Narasimhan and Colleagues (Impact of a Telepsychiatry Program at Emergency Departments Statewide on the Quality, Utilization, and Costs of Mental Health Services). (2016, March 21). Mental Health Weekly Digest.

Reinhardt, I., Gouzoulis-Mayfrank, E., & Zielasek, J. (2019). Use of Telepsychiatry in Emergency and Crisis Intervention: Current Evidence. Current psychiatry reports, 21(8), 63. https://doi.org/10.1007/s11920-019-1054-8

Reliford, A., & Adebanjo, B. (2019). Use of Telepsychiatry in Pediatric Emergency Room to Decrease Length of Stay for Psychiatric Patients, Improve Resident On-Call Burden, and Reduce Factors Related to Physician Burnout. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 25(9), 828–832. https://doi.org/10.1089/tmj.2018.0124

Southard, E. P., Neufeld, J. D., & Laws, S. (2014). Telemental health evaluations enhance access and efficiency in a critical access hospital emergency department. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 20(7), 664–668. https://doi.org/10.1089/tmj.2013.0257