Receipt of Telepsychiatry and Emergency Department Visit Outcomes in New York State

Abstract

Telepsychiatry has made psychiatric care more accessible to emergency department (ED) patients. To date, most telepsychiatry studies have focused on specific populations or small groups of EDs. This study sought to examine the potential role of telepsychiatry across a wider range of EDs by comparing visit dispositions for psychiatric visits in EDs that did (versus did not) receive telepsychiatry services. ED telepsychiatry service status was identified from the 2016 National ED Inventory-USA and then linked to psychiatric visits from the 2016 New York State Emergency Department Databases/State Inpatient Databases. Unadjusted analyses and multivariable logistic regression models were used to evaluate associations between an ED’s telepsychiatry service status and two clinical outcomes: use of observation services and ED visit disposition. Across all psychiatric ED visits, 712,236 were in EDs without telepsychiatry while 101,025 were in EDs with telepsychiatry. Most (99.8%) visits were in urban EDs. In multivariable logistic regression models, psychiatric visits in EDs with telepsychiatry services had lower odds (adjusted odds ratio 0.30) of using observation services compared to visits in EDs without telepsychiatry. The receipt of ED telepsychiatry is associated with lower usage of observation services for psychiatric visits, likely reducing the amount of time spent in the ED and mitigating the ongoing problem of ED crowding. An overwhelming majority of visits in EDs with telepsychiatry services were in urban hospitals with existing psychiatric services. Factors affecting the delivery and effectiveness of telepsychiatry services to hospitals lacking in psychiatric resources merit further investigation. Supplementary Information The online version contains supplementary material available at 10.1007/s11126-021-09886-y.

Hospital Capabilities Associated With Behavioral Health Integration Within Emergency Departments

“…Prior research observed that the receipt of telepsychiatry in the ED was associated with improved outcomes including reduced time in the ED, less crowding, reduced travel time for physicians, and improved access to onsite psychiatric consultation. 9,10 Patients with BH conditions need coordinated and accessible care across community and hospital settings. Our null results suggest that hospitals need more resources to integrate BH processes in the ED, including licensed psychiatrists or other BH providers, reimbursement mechanisms for telepsychiatry, and increased access to community-based BH care providers.…”

“…5 These processes have been shown to efficiently identify previously undiagnosed BH problems, 6,7 reduce wait times and time in the ED, and improve access to psychiatric consultation. [8][9][10] The extent to which US hospital EDs have implemented recommended BH processes and whether specific hospital capabilities can support the integration of BH processes within EDs remains unclear. This study aims to understand the extent to which hospital capabilities are associated with greater adoption of BH care processes in ED.…”

“…To improve ED care, the American College of Emergency Physicians recommends that EDs integrate multiple BH processes, including routine screening for BH concerns such as alcohol use disorders and intimate partner violence, telehealth, the use of interdisciplinary team-based care, and referrals for ongoing care of BH conditions 5 . These processes have been shown to efficiently identify previously undiagnosed BH problems, 6,7 reduce wait times and time in the ED, and improve access to psychiatric consultation 8–10 …”

Beam Me Out: Review of Emergency Department Telepsychiatry and Lessons Learned During COVID-19

“…The literature on EDTP published in the past 2 years shows evidence that telepsychiatry implementation is associated with shorter wait times [18 •, 19, 24], increased access [18•, 25•], more discharges to home [21,22], and increased sense of personal safety for providers [25•]. The receipt of EDTP is associated with lower usage of observation services for psychiatric visits, reducing the amount of time spent in the ED, and addressing the longstanding problem of ED crowding [22]. EDTP can also reduce ED LOS for pediatric patients and reduce travel for face-to-face evaluations, saving up to 2.22 h each day for on-call providers [18•].…”

“…Zhong and colleagues shed a different light on ED efficiency by assessing the impact of observation visits (stays of 8-48 h) on disposition across a larger cohort of psychiatric visits to EDs with and without EDTPs by linking the 2016 National ED Inventory-USA to psychiatric visits from the 2016 New York State ED Databases/State Inpatient Database [22]. They demonstrated that psychiatric visits in EDTPequipped EDs used less observational services (2.3% of ED visits) compared to those without EDTP capacity (2.7%) with adjusted odds ratio 0.30 and concluded that receipt of EDTP was associated with "lower usage of observation services for psychiatric visits, likely reducing the amount of time spent in the ED and mitigating the ongoing problem of ED crowding" [22]. There is also evidence that the implementation of a virtual patient navigation program in six EDTP-equipped EDs spanning urban and suburban locations across North Carolina, South Carolina, and Georgia decreased the admission rate for patients with mental health outcomes and reduced the number of follow-up encounters involving self-harm diagnosis within 45 days [23 •].…”