Andy Flanagan

Tackling emergency department overcrowding with telepsychiatry

February 06, 2023
By Andy Flanagan

Often crowded, chaotic, and understaffed with long wait times, hospital emergency departments are not the ideal setting in which to deliver mental health services to patients. But, on average, one in eight ED visits in the U.S. is related to a mental health or substance use disorder. Hospitals have seen a 24% spike in mental health ED visits for children aged 5 to 11 and a 31% increase for adolescents aged 12 to 17. This increase in behavioral health visits places stress on EDs, which are better designed and staffed to assess and treat surgical and medical needs and often lack the staff and resources to handle behavioral health issues.

Recently, EDs have reached a breaking point due to a lack of available inpatient beds and staffing shortages. Rather than letting a patient in crisis leave, they choose psychiatric boarding, in which patients are held for long periods of time before receiving treatment. According to the Joint Commission, psychiatric boarding can increase stress on patients who may already be in crisis. Additionally, ED boarding can:

1. Consume scarce ED resources and increase pressure on staff
2. Delay mental health treatment that could mitigate the need for inpatient stay
3. Increase ED crowding
4. Extend wait times for all patients in the ED
5. Pose a significant financial impact on ED reimbursement

How telepsychiatry improves care in the ED
Telepsychiatry can enable EDs to deliver needed mental health care without additional resources or personnel. Telepsychiatry delivered by a qualified vendor partner gives hospital EDs the ability to provide patients with high-quality psychiatric care through virtual visits. Patients do not have to wait hours to receive treatment from an ED physician or an in-person consultation from a psychiatric provider, which, according to one study, can reduce their length of stay in the ED by as much as 62%.

Telepsychiatry also reduces the burden on attending physicians and ED staff by giving them access to psychiatric providers who can quickly assess and treat patients, freeing up ED team to focus on patients who come in for medical and surgical needs.

Telehealth is growing in popularity. According to the APA, nearly 38% of Americans have used telehealth services to meet with a medical or mental health professional. The report also found that nearly six in 10 would use telehealth services for mental healthcare. As public acceptance grows, more and more healthcare organizations are following their lead. In the American Hospital Association’s report on telehealth, as of 2017, 76% of hospitals reported utilizing telehealth.

Overcoming telepsychiatry challenges and misconceptions in the ED
While the use of telehealth is on the rise in hospitals, there is some hesitancy about virtual solutions in such a sensitive area and complicated setting:

1. Discomfort with technology: Some hospitals are concerned about using and managing telehealth technology correctly. However, a technology-neutral telehealth provider can integrate the technology with a hospital’s existing systems and equipment.
2. Concerns about efficacy: A common misconception about telepsychiatry in the ED is that it isn’t as effective as in-person treatment. However, a telepsychiatrist, in collaboration with on-call staff, can assess patients, manage risks, and create a treatment plan to properly treat patients — just like an in-person provider.
3. Staff receptiveness: Any initial reservations from staff can be overcome through communication, education on processes and procedures, and staff support.

By leveraging telepsychiatry, EDs can improve their throughput and improve outcomes for patients, staff, and the entire healthcare organization.

Benefits of telepsychiatry in the ED
Telepsychiatry benefits EDs and patients by assessing patient needs and managing their risk to ensure each receives proper treatment and is dispositioned quickly.

Other benefits include:
• Improved accessibility for patients who are disabled, elderly, or located in remote or rural locations
• Better outcomes due to integrated behavioral health and primary care
• Reductions in delayed care
• Increased feelings of safety, security, and privacy for patients

Telepsychiatry also helps EDs overcome staffing shortages by providing access to psychiatrists around the clock. That makes it possible for more patients to get the care they need in a hospital setting without long waits.

Telepsychiatry transforms ED patient care
In an analysis of ED visits for mental health and substance use, 14.2% of patients returned to the ED or hospital within 30 days. The good news is health systems are beginning to see the impact consistent behavioral health services have on reducing ED bounce-backs and visit costs, which can be upwards of $6 billion according to the Healthcare Cost and Utilization Project.

Finally, telepsychiatry saves hospitals money and frees up bed space by reducing inpatient admissions as much as 5%. With telepsychiatry, patients no longer need to wait hours for treatment from an ED physician or an in-person consultation from a psychiatric provider, which can drastically reduce their length of stay in the ED. As a result, hospitals can help more people in the community, increase throughput in their ED, and relieve pressure on their providers and overall organization.

About the author: Andy Flanagan is the CEO of Iris Telehealth.