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Finding high quality mental health care is difficult, regardless of the location of the patient or his life. of tele-behavioral health in recent years, it is considerably less difficult. And as the regulatory environment becomes more welcoming, with the adoption of legislation on the parity of telemedicine inspired by the project ECHO can be expected that this trend of growth continues.
The greatest potential for tele-behavioral health, however, is not so much in the outpatient space but in short-term care: Tele-behavioral health can dramatically improve l & # 39; access to psychiatric care on an emergency basis, avoid unnecessary transfers and readmissions, reduce waiting times for patients and even minimize the symptoms of burnout among doctors.
These are increasingly important benefits that hospitals and health systems need to consider when developing their plans for launching or expanding telehealth services.
Assessment of Behavioral Health Problems in Acute Care Facilities
Each acute care setting is different, but most share the same systemic challenges to meet the needs of patients, particularly behavioral health needs .
The biggest challenge is meeting the needs of the large number of patients who need mental health services. An estimates that one in five adults in the United States – 43.8 million – is suffering from a mental illness in a given year. Conversely, the number of primary care physicians – the professionals who are traditionally the first responders in the treatment of adults with behavioral health needs such as substance abuse and depression – is steadily declining. And according to a recent estimate 56% of American adults with a mental illness do not receive treatment.
Unsurprisingly, acute care facilities, such as community hospitals, are often the first stop for these patients. As indicated by a study presented at the 2016 meeting of the American College of Emergency Medicine, three quarters of emergency physicians responding to a survey report having seen patients at least once by quarters and requiring hospitalization for psychiatric treatment; Nearly one-quarter (21%) say they have patients waiting two to five days for inpatient beds. A separate study published by the Annals of Emergency Medicine found that patients with bipolar disorder, psychosis, dual diagnosis, multiple psychiatric diagnoses, and depression had increased odds of becoming pregnant. be in an emergency situation. department of more than 24 hours.
The number of patients with substance use disorders seeking immediate medical attention at an emergency is particularly troublesome. Unfortunately, many of these people hope to get opioids or other narcotics, rather than the behavioral health services they need.
However, ED physicians are generally not trained to deal with substance abuse problems – their job is to stabilize, treat and discharge patients. In addition, finding qualified personnel to treat a patient's behavioral health problems can take hours, increasing the risk of an adverse outcome. Patients with substance abuse problems are also known to threatening physicians. For some doctors, it may seem easier to find a quick fix, such as prescribing an opioid, to spend more time on patients who face life-threatening emergencies.
As a result, long-term behavioral needs – such as linking patients to appropriate rehabilitation programs or case managers who oversee continuing care – are often ignored. This can create a vicious circle, exposing patients to an increased risk of readmission to the hospital or an adverse event.
Integrating Tele-Behavioral Health
When administered correctly, tele-behavioral health can offer immediate relief and elevate care in acute settings. But it is important to remember that virtual consultation is only one aspect of care. In our experience, an acute care facility will only benefit from the maximum benefits of tele-behavioral health through a system-wide, holistic approach that uses a telehealth platform interoperable with the health record system. existing electronics of an organization. technologies. This approach allows faster and more accurate sharing of care and information and better collaboration between multiple providers.
To better understand these benefits, it is helpful to examine some of the most common behavioral health scenarios in the emergency department. would allow better care.
In our first scenario, a 45-year-old man comes to the hospital complaining of anxiety, plagued by signs of panic attack. At admission, a triage nurse offers the patient the opportunity room for a virtual consultation with a remote psychiatrist, instead of waiting several hours to be seen by a doctor. The patient meets the psychiatrist on a video screen, who talks to him about his lifestyle, the medications and other factors that contributed to his current condition. After badessing the patient's anxiety at the end of the consultation, the psychiatrist makes an appointment with a primary care physician or a mental health care provider who can consult with him or her on an ongoing basis. The telehealth consultation ends and is documented in the same program as the virtual tour, ensuring a smoother transition between care settings.
In our second scenario, a 24-year-old patient presents in the emergency room. long-term injuries and demanding opioids. A nurse looks at her medical record and sees that she has a history of repeated use but no visible injury. Instead of giving in to the patient's requests for OxyCodone, the nurse uses the hospital's telehealth platform to contact an addiction professional, who can recommend a more appropriate intervention and follow-up .
These are just two cases of acute use demonstrating the vast potential of tele-behavioral health.
The integration of tele-behavioral health in acute care settings can immediately and significantly improve patient flow, reduce readmissions to the hospital and, ultimately, change the lives of patients and patients. their relatives.
In the future, organizations would benefit from the broader impact of behavioral telehealth on clinical workflows, outcomes, and overall operations. Putting the patient in touch with the right mental health professional as quickly as possible can improve their overall health and ensure that acute care facilities are not slowed down in their mission to save lives, a patient at the heart of their lives. time.
Mike Baird is co-founder and CEO of Avizia, a leading provider of telehealth services at the system level.
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