The Use of Telepsychiatry to Provide Cost-Efficient Care During Pediatric Mental Health Emergencies

• Published in: Psychiatric services (Washington, D.C.) Vol. 69; no. 2; pp. 161 - 168
• Main Authors: Thomas, John F, Novins, Douglas K, Hosokawa, Patrick W, Olson, Christina A, Hunter, Dru, Brent, Alison S, Frunzi, Gerard, Libby, Anne M
• Format: Journal Article
• Language: English
• Published: United States American Psychiatric Association 01-02-2018; American Psychiatric Publishing, Inc
• Subjects: Adolescent; Child; Child, Preschool; Colorado; Cost-Benefit Analysis; Cross-Sectional Studies; Emergencies; Emergency Services, Psychiatric - economics; Emergency Services, Psychiatric - organization & administration; Female; Hospitals, Pediatric; Humans; Infant; Length of Stay - statistics & numerical data; Logistic Models; Male; Mental Disorders - economics; Mental Disorders - therapy; Mental health; Multivariate Analysis; Parents - psychology; Patient Satisfaction; Pediatrics; Psychiatry; Referral and Consultation; Telemedicine; Telemedicine - organization & administration; Telemedicine - statistics & numerical data; Videoconferencing; Young Adult; Colorado; Assessment/psychiatric; Adolescents/adolescence; Telecommunications; Mental health systems/hospitals; Telehealth; Emergency psychiatry
• ISSN: 1075-2730; 1557-9700
• DOI: 10.1176/appi.ps.201700140

Objective:This study evaluated a videoconference-based psychiatric emergency consultation program (telepsychiatry) at geographically dispersed emergency department (ED) sites that are part of the network of care of an academic children’s hospital system. The study compared program outcomes with those of usual care involving ambulance transport to the hospital for in-person psychiatric emergency consultation prior to disposition to inpatient care or discharge home.Methods:This study compared process outcomes in a cross-sectional, pre-post design at five network-of-care sites before and after systemwide implementation of telepsychiatry consultation in 2015. Clinical records on 494 pediatric psychiatric emergencies included ED length of stay, disposition/discharge, and hospital system charges. Satisfaction surveys regarding telepsychiatry consultations were completed by providers and parents or guardians.Results:Compared with children who received usual care, children who received telepsychiatry consultations had significantly shorter median ED lengths of stay (5.5 hours and 8.3 hours, respectively, p<.001) and lower total patient charges ($3,493 and $8,611, p<.001). Providers and patient caregivers reported high satisfaction with overall acceptability, effectiveness, and efficiency of telepsychiatry. No safety concerns were indicated based on readmissions within 72 hours in either treatment condition.Conclusions:Measured by charges and time, telepsychiatry consultations for pediatric psychiatric emergencies were cost-efficient from a hospital system perspective compared with usual care consisting of ambulance transport for in-person consultation at a children’s hospital main campus. Telepsychiatry also improved clinical and operational efficiency and patient and family experience, and it showed promise for increasing access to other specialized health care needs.