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The issue has plagued health systems for decades. EDs are often loud, busy places, where the emphasis is on stabilizing and treating emergencies. Patients with mental or behavioral health concerns are often brought to the ED because there’s nowhere else to go, and they have to wait for a specialist to examine and diagnose them. Few hospitals have those specialists on hand, so the wait is even longer to get them to the hospital. In some cases patients are even discharged from the ED with an appointment to see a psychiatrist or other specialist, delaying care even longer and giving the patient an opportunity to skip care altogether.
Add in the chaos caused by the coronavirus pandemic, or even a busy flu season, and the gap widens for mental and behavioral health patients needing access to care.
At Cleveland Clinic Indian River, those specialists were housed in a facility across the street, but they had their own busy workloads and couldn’t just drop everything at a moment’s notice except for those cases deemed critical.
Recognizing the problem, the hospital, which has partnered with AmWell for telehealth services since 2018, created a telemental health platform. ED staff can now request a virtual psych consult, and connect a patient with a specialist across the street in less than an hour.
“You want to free up the (staff and doctors) in the emergency department to do other things,” says Posey.
A telemental health platform in the ED addresses several pain points. ED staff are usually not trained to assess mental and behavioral health cases, so they might not recognize those in need of urgent care, making the immediacy of a psych consult all the more important. On the other hand, many mental health patients are sent to the ED for clinical reasons, such as an injury or substance abuse issue, so a timely psych consult can help speed up clinical care.
Posey says the telehealth platform enables ED staff and providers to focus on clinical issues, knowing the psych consult will happen sooner rather than later. This meant that a patient would be diagnosed more quickly, and either gotten out of the ED and to a more appropriate setting or given the treatment they need, such as medication.
“The biggest challenge we had at first was the implicit bias that we see in telehealth,” she says. “Patients were saying they wanted to see a real doctor. Sometimes you have to get them used to (telehealth), and then they’ll realize that they’ll be able to see a doctor more quickly.”
Posey says ED access to specialists through telehealth “has been a game-changer,” and that it helps to promote collaboration between different departments. It reduces the time to diagnosis, enabling patients to get the care they need sooner, and it reduces the time spent waiting around in the ED, which in turn reduce ED crowds.
She expects that telehealth use will expand in the ED eventually, giving the busy department access to more specialists and allowing for coordination on more services.
“People are really starting to see the advantages,” she says. “Not only that it speeds things up, but that it can improve the quality of care.”
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