Telepsychiatry by a Public, Academic Medical Center for Inpatient Consults at an Unaffiliated, Community Hospital

Abstract

Background: Telepsychiatry has the potential to help address the uneven distribution of psychiatrists between urban and rural areas. While telepsychiatry has been used for several decades, employing video conferencing technologies to conduct psychiatry consults to the medical wards of rural hospitals is a more recent application.

Objective: To develop the first US program wherein psychiatrists covering the consult service at a public, academic medical center also delivered same-day consults to patients on the medical wards of unaffiliated, rural hospitals.

Methods: We describe the rationale, workflow, technology, case distribution, benefits, and lessons learned from the first 24 months of the service.

Results: The program resulted in 156 initial and follow-up consults wherein patient interviews were conducted via live videoconference. An additional 19 "curbside" consults were done via hospitalist-to-psychiatrist phone calls. Though the initial impetus for the development of the program was to manage involuntarily-detained patients awaiting the availability of a psychiatric bed, the availability of the psychiatrists resulted in the service being used for a wide range of situations and diagnoses.

Conclusion: Given the benefits noted by consultants, patients, and community hospital medical staff, the program could be replicated by other institutions.

Keywords: consultation liaison psychiatry; delirium; suicide; telepsychiatry.