In the JournalsPerspective

80% of EDs do not receive telepsychiatry services

Rain E. Freeman

Researchers have found that 20% of EDs in the United States receive telepsychiatry services, according to results of a national survey study published in Psychiatric Services.

“Although telepsychiatry may help many EDs access emergency psychiatric care, there were still 80% of U.S. EDs that did not report receiving telepsychiatry in 2016," Rain E. Freeman, MPH, of the department of emergency medicine at Massachusetts General Hospital, told Healio Psychiatry. “EDs may benefit from telepsychiatry, especially if they currently have no other form of emergency psychiatric services.”

Although telepsychiatry is becoming increasingly common in EDs, little research exists regarding this approach. To investigate its prevalence and applications in general EDs in the U.S., the researchers surveyed all 5,375 American EDs in 2016. A total of 4,507 (84%) responded. Of those reporting telepsychiatry services, Freeman and colleagues selected a 15% random sample for a second survey that confirmed telepsychiatry use in 2017. This survey also collected data on applications of telepsychiatry and emergency psychiatric services in each ED.

According to the data from the first survey, 885 (20%) EDs reported receiving telepsychiatry. EDs with a rural location, Critical Access Hospital Designation and higher annual total volume visits were more likely to receive these services, and those that reported being an autonomous freestanding ED were less likely to receive them.

Data from the second survey, which received 105 responses for an 81% response rate, 95 (90%) reported telepsychiatry use. Of these, most (59%) reported telepsychiatry as their only form of emergency psychiatric services. Moreover, 25% received services once a day or more. Telepsychiatry was most commonly used in admission or discharge decisions (80%) and transfer coordination (76%).

“We were a bit surprised at first to find that so many of the EDs we surveyed reported no other form of emergency psychiatric services besides telepsychiatry," Freeman said. "In the beginning, we assumed telepsychiatry complemented other emergency psychiatric services for most EDs, especially where such services were limited. This finding really highlighted for us why telepsychiatry is so critical for many EDs." – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures.

Rain E. Freeman

Researchers have found that 20% of EDs in the United States receive telepsychiatry services, according to results of a national survey study published in Psychiatric Services.

“Although telepsychiatry may help many EDs access emergency psychiatric care, there were still 80% of U.S. EDs that did not report receiving telepsychiatry in 2016," Rain E. Freeman, MPH, of the department of emergency medicine at Massachusetts General Hospital, told Healio Psychiatry. “EDs may benefit from telepsychiatry, especially if they currently have no other form of emergency psychiatric services.”

Although telepsychiatry is becoming increasingly common in EDs, little research exists regarding this approach. To investigate its prevalence and applications in general EDs in the U.S., the researchers surveyed all 5,375 American EDs in 2016. A total of 4,507 (84%) responded. Of those reporting telepsychiatry services, Freeman and colleagues selected a 15% random sample for a second survey that confirmed telepsychiatry use in 2017. This survey also collected data on applications of telepsychiatry and emergency psychiatric services in each ED.

According to the data from the first survey, 885 (20%) EDs reported receiving telepsychiatry. EDs with a rural location, Critical Access Hospital Designation and higher annual total volume visits were more likely to receive these services, and those that reported being an autonomous freestanding ED were less likely to receive them.

Data from the second survey, which received 105 responses for an 81% response rate, 95 (90%) reported telepsychiatry use. Of these, most (59%) reported telepsychiatry as their only form of emergency psychiatric services. Moreover, 25% received services once a day or more. Telepsychiatry was most commonly used in admission or discharge decisions (80%) and transfer coordination (76%).

“We were a bit surprised at first to find that so many of the EDs we surveyed reported no other form of emergency psychiatric services besides telepsychiatry," Freeman said. "In the beginning, we assumed telepsychiatry complemented other emergency psychiatric services for most EDs, especially where such services were limited. This finding really highlighted for us why telepsychiatry is so critical for many EDs." – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Hossam Mahmoud

    Hossam Mahmoud

    Based on a study conducted by Freeman and colleagues between 2016 and 2017, an estimated 20% of EDs in the U.S. utilized telepsychiatry services. Furthermore, for almost 60% of EDs, telepsychiatry appeared to be the only option available for patients in crisis. The researchers add, “Telepsychiatry is used quite frequently among receiving EDs, and it commonly assists with admission and discharge decisions and with coordinating transfer and placement, which may affect ED boarding and crowding.”

    My first impression reading the article was that 20% seemed like a low percentage. However, having been in the field of telepsychiatry for several years, I also realized that in the past 3 years, telepsychiatry implementation has expanded more rapidly than could have been predicted. There have historically been significant barriers to the scaling of telepsychiatry programs, but many of these barriers have been significantly mitigated. Scaling has been successful and feasible due to changing attitudes and increased acceptability, decreased hardware and software costs, convenience for patients and clinicians, enhanced internet connectivity across many parts of the country and improvement in reimbursement. I am hopeful that a follow-up study conducted today would demonstrate that a significantly higher percentage of EDs are using telepsychiatry in 2020.

    • Hossam Mahmoud, MD, MPH
    • Senior vice president and medical director
      Scheduled Services and Inpathy, InSight + Regroup
      President
      Illinois Psychiatric Society

    Disclosures: Mahmoud reports being the senior vice president and medical director of a telepsychiatry company.