Development of a Virtual Consultation-Liaison Psychiatry Service: A Multifaceted Transformation

Abstract

In response to the coronavirus disease 2019 (COVID-19) pandemic, our NYU Langone Health Tisch/Kimmel/Orthopedic Hospital Consultation-Liaison (CL) Psychiatry service underwent a multifaceted transformation to become a primarily Virtual CL Psychiatry service. We aimed to provide the hospital system with comprehensive psychiatric consultation for all patients, regardless of isolation status, while preserving personal protective equipment and avoiding unnecessary exposure to COVID-19 for our team members. In this article, we discuss harnessing technology for video consultations and transforming the multiple facets of an academic CL Psychiatry Service to become a comprehensive, functioning virtual consultation team during the COVID-19 pandemic. We review the history, best practices, legal, and regulatory considerations of using telepsychiatry for psychiatric consultations, challenges to implementation across multiple clinical sites, and expansion of the liaison role to include support of frontline colleagues. Finally, we provide the physician, trainee, and psychiatric nurse perspective as it relates to this transition. [ Psychiatr Ann . 2020;50(7):279–287.]

Acceptability and Feasibility of Virtual Behavior Analysis Supervision

“…The nature of the virus has necessitated individuals, communities, and institutions to assess the need for in-person interactions and move to a virtual modality to reduce the spread of the virus. This move to virtual work was initially intended to both conserve personal protective equipment for healthcare providers and to reduce the overall spread of the virus to "flatten the curve" of COVID-19 cases (Caravella et al, 2020). However, the move to virtual modalities has had a significant impact on how individuals, communities, and institutions function.…”

“…Although the pandemic has affected the functionality of many occupations, the effects are particularly significant for healthcare professions that require in-person interactions with clients to deliver treatment services. In addition to disrupting clinical services, the COVID-19 pandemic also affected trainees' opportunities for continued education and supervision (Caravella et al, 2020). The COVID-19 pandemic in the United States led to the closure of institutions of higher education, restriction of practicum and internship placements, and a shift to virtual learning in March 2020 (Kim, 2020).…”

“…Although virtual supervision has recently been adapted in the field of behavior analysis, it has a long history of use across fields such as psychotherapy (Caravella et al, 2020), counseling (Nadan et al, 2020), education (Kim, 2020), speech therapy (Dudding & Justice, 2004), social work (Panos et al, 2002), and medical services (Wearne et al, 2015). Overall, studies have shown that virtual supervision has maintained adequate quality of supervision and positively affected the development of trainee competence in multiple domains of counseling and psychotherapy (Manring et al, 2011;Nadan et al, 2020).…”

Adaptations Made to Pediatric Consultation-Liaison Psychiatry Service Delivery During the Early Months of the COVID-19 Pandemic: A North American Multisite Survey

“…Establishing the nature and effectiveness of these adaptations is an important exercise that may help inform future models of care and best practices. Changes made to single center adult consultation-liaison (CL) services, 31 , 32 , 33 , 34 , 35 , 36 , 37 a pediatric psychology CL service 38 and a neonatal intensive care service 39 have been described. However, to our knowledge, this is the first multi-center study describing changes made to PCLPSs across North America.…”

Increased referrals to an Australian Consultation Liaison Psychiatry service during the COVID-19 pandemic

“…CL psychiatry services had to flexibly adapt to rapid changes in the hospital environment including the use of telehealth at the bedside, personal protective equipment during patient interviews, and limits on staff gatherings for teaching, reflection and socialising. 7 Being the most accessible MH professionals within the hospital, CL services also played a pivotal role in the well-being of the hospital itself, often acting as a container for the anxiety and distress of healthcare workers. 8 These were all likely contributors to a shared observation of increased workload within the service.…”