- In busy emergency departments across the country, doctors are turning to telemedicine to provide one vital service they can’t often handle: the psychiatric consult.
Roughly 13 percent of all ER visits require a mental health consult, according to a 2016 study published in Health Affairs. And that percentage is increasing: The American College of Emergency Physicians notes that more psychiatric cases are winding up in the ER because resources for treating them are stretched thin and more people are being diagnosed as in need of mental healthcare. Yet at the same time, the number of psychiatric beds in EDs has dropped from about 500,000 in the 1970s to 113,569 in 2010.
Amid a national shortage of mental health providers and with few hospitals having a specialist on hand, patients in need of a consult end up staying in the ER an average of 23 hours, about 14 hours longer than the national average in 2011. In some cases, hospitals are stretching their services to accommodate patients who just wait around for hours; in others, those patients are released, untreated.
In this climate, health systems with psychiatric services are finding value in telemedicine – for their own patients and providers as well as through a new business line.
In St. Mary’s Regional Medical Center in Lewiston, Maine, hospital officials added emergency behavioral healthcare service shortly after renovating their ED in 2010. Using a basic video visit platform, they’re able to link patients in the ER with an available mental health professional at any time of the day or night.
“It was very difficult,” Melinda Lovering, business manager at the 233-bed hospital, said of the ED prior to launching a telemedicine platform. “They could obviously take care of people when it’s a medical issue, but [without an available psych consult] they either had to keep someone a lot longer or send them right back out onto the street.”
Allowing ER patients to see a counselor through a virtual visit “created a significant improvement in patient care,” says Paul Rouleau, RN, director of behavioral operations for St. Mary's Health System and Community Clinical Services.
Rouleau says Maine struggles to take care of its behavioral health patients because of its rural nature. The state offers only three psychiatric facilities and five hospitals with psychiatric services, serving a sprawling, diverse area of some 2 million residents (and many more visitors during the summer).
“Maine is a small town,” adds Jason Rosenberg, RN, the health system’s director of behavioral services, noting the state has very few large population centers but a lot of rural-minded communities with health clinics, doctor’s offices and the occasional small hospital. This makes access to specialists difficult, whether it’s in the remote potato communities of northern Maine, the hunting and fishing camps of western Maine, the isolated fishing communities along the Downeast coast or even in the more urban southern counties.
In setting up a telepsychiatry service, Rosenberg says St. Mary’s was looking to set a new standard of care for ED patients in a state where this service hadn’t been available. They didn’t have a model to work with, he says, and found that the best way to create this platform was to make it as simple as possible to use.
They also learned quickly that the service was lacking one thing: patients. Helping four or five patients in a week might be good for those particular patients, but it’s very hard to sustain the platform on that amount of business.
“We had tons of capacity here,” says Rouleau.
So they branched out, offering their telepsych consults to other providers in Maine and neighboring New Hampshire.
The concept is proving popular in other parts of the country as well, where small health systems get together and, in essence, trade what services they can offer through telemedicine with other providers who can offer different services.
“There was a lot of skepticism at first,” Rouleau says. “We reminded them that they didn’t have anyone in person to start with.”
St. Mary’s also had to get beyond the idea of competition that crops up from time to time in an area served by multiple healthcare providers. One health system offering a service that others don’t have is not a bid to take away business from others – it’s an effort to provide healthcare services that are much needed and not offered.
“All of the hospitals in Maine share the same patients,” Rouleau says. “It’s in their best interest that we do this.”
Aside from hospitals, St. Mary’s is also expanding its service to nursing homes (they have one of only three geriatric psychiatrists in the state) and on-call programs. There’s also a huge need in the state for child and adolescent psychiatric services, which could someday lead to partnerships with behavioral health clinics and school systems.
“It’s secure, it’s inexpensive for facilities to set up,” says Rosenberg. “There’s no need for extra gear. All you need is a quality camera and an online connection.”
“We have to keep the overhead minimal,” adds Rouleau, noting they’re looking into providing the service on iPads as well. “Don’t go robust with hardware or software. Make it as simple as you can for people to use, and be sure that you can do it regularly. It has to be part of your routine.”
Based on the success of the ER telepsychology platform, St. Mary’s is also launching a teleneurology pilot, with an eye toward a telemedicine-based sleep medicine program on the horizon.
“We have several other specialists that have gotten wind of what we’re doing,” says Lovering. “There’s just so much potential.”