Memorial Medical Center is using technology to broaden patient access to psychiatry services in emergencies.
The Modesto hospital at Briggsmore Avenue and Coffee Road rolled out telepsychiatry service in July and already has assisted dozens of patients in crisis who came through the emergency-room doors.
The work station, with a 22-inch screen, is wheeled to the patient’s bedside in the emergency department or an inpatient room if an on-call psychiatrist is not available locally. Patients are able to talk with a specialist for an evaluation that will help providers in the hospital support them through the crisis and meet their needs.
The evaluations take about 30 minutes. The psychiatrist then discusses the patient’s condition with the attending physician or an emergency medical provider and recommends medication and follow-up care.
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Memorial is part of the Sacramento-based Sutter Health system, which also has launched the service at Sutter Tracy Community Hospital and Memorial Hospital Los Banos, where local access to psychiatry is more scarce.
Sutter has a partnership with Virtual Medical Staff for making the video connections with on-call psychiatrists in Northern and Southern California, Florida and other locations. The system uses Skype for Business.
“The feedback we have received has been positive,” said Tim Jones, telepsychiatry program manager for Sutter Health. “There is a dearth of psychiatric providers in a lot of communities we serve. It would be a challenge to staff every one of our hospitals with 24/7 psychiatry to respond to emergency needs.”
With the new service, Jones added, “we can treat the whole person in the acute care environment.”
For the most part, the telepsychiatry program at Memorial is for people 13 years and older. The service is only for emergency cases. It’s not for providing a definitive diagnosis of a patient’s mental illness, and outpatient care is often recommended for patients released from the hospital.
When a patient needs the service at Memorial, a staff member enters a consult order in the person’s electronic health record and a nurse contacts a telepsychiatry call center. After the patient’s information, primary language and nature of the request is taken down by the call center, an on-call psychiatrist is usually available within an hour, Sutter said.
Once the cart is brought to the patient’s bedside, the camera can be moved around, allowing the psychiatrist hundreds or thousands of miles away to talk with a family member if needed. The phone speaker has a feature for removing background noise.
Karen Turner, nurse manager for the emergency department and trauma services at Memorial, said ideally the assessment is done in the quiet of a private room where it’s easy to maintain confidentiality. She said some psychiatric patients don’t want to talk and require encouragement.
Jones said most patients suffering from an episode can “reality test”, meaning they fully understand they’re communicating with a specialist on the screen. An assessment might be delayed in severe cases until an appropriate time, he said.
The telepsychiatry service is not used for ordering “5150” holds for people who are a danger to themselves or others or are gravely disabled, Jones said. Under state law, that formal assessment requires an ink-on-paper signature and is handled by in-house staff or a county mental health professional.
Turner said emergency department staff have grown accustomed to telemedicine, including a telestroke service at Memorial.
Since launching telepsychiatry in October 2017, Sutter Health has expanded the service to about half its facilities in Northern California. Almost 1,300 evaluations were completed in Sutter hospitals from October through August.
The American Psychiatric Association has recognized that telepsychiatry has benefits by improving access to mental health assessments, reducing delays in care and improving continuity of treatment. According to the association, California is one of 32 states with a parity law for insurance to cover telemedicine.