Some states are implementing telepsychiatry programs to expedite the provision of psychiatric care to patients in crisis and to potentially reduce the incidence of boarding psychiatric patients in the ED. There have been recent published reports about a few of these programs in North and South Carolina. Those reports, coupled with input from emergency physicians in these states, indicate mixed results and provide potentially helpful information for chapters in other states contemplating similar initiatives.

In 2010, North Carolina began a telepsychiatry program in one rural area of the state and subsequently enacted legislation for a statewide program in 2013. According to a study from the North Carolina Center for Public Policy Research, the initial regional program improved patient outcomes and reduced the length of stay in emergency departments for patients awaiting discharge to inpatient facilities from 48 hours to 22.5 hours.¹ But the report also noted barriers to adoption of the program (including concerns related to licensure, liability, and reimbursement) and made recommendations for additional state action.

Some emergency physicians in North Carolina reported serious concerns about the program, including prolonged waits in getting a teleconsult and extended lengths of stay in the ED (up to an average of 60 hours in some locations) after the consulting psychiatrist determined patients needed to be admitted. However, efforts to address these concerns were also noted and included hospital initiatives to move admitted psychiatric patients out of the ED until final placement can be arranged. Other emergency physicians reported success with the program in their hospitals, particularly after having time to work through some of the issues noted above. They added that emergency physicians have come to trust the patient care received via telepsychiatry.

Meanwhile, five years ago, South Carolina launched a regional telepsychiatry program that was the subject of a Stateline article by The Pew Charitable Trusts a few months ago.² The article indicated that average wait times for a psychiatric examination dropped from four days to less than 10 hours. However, reports from some South Carolina emergency physicians indicated a variety of problems with the program, including the frequent reluctance of telepsychiatrists to send anyone home due to liability concerns, resulting in extended ED stays while trying to place patients who might otherwise have been sent home. That led some hospitals to drop the program.

While telepsychiatry seems to be showing signs of promise in some parts of the Carolinas, there are clearly still ample examples of implementation issues that must be resolved at the local level and that should be anticipated if similar telepsychiatry programs are implemented in other states.

References

1. Holton A, Brantley T, Duda A; North Carolina Center for Public Policy Research. Telepsychiatry in North Carolina: mental health care comes to you. North Carolina Insight. March 2014.
2. Vestal C. Getting rural patients psychiatric help fast. Stateline. June 26, 2014.

Mr. Price is ACEP’s associate executive director for policy and administration.