Making Tele-Behavioral Health a Success in Hospital Settings

Mike Baird, MBA
JULY 02, 2018
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Finding high-quality mental healthcare is challenging, regardless of a patient’s location or life circumstances.

But with the explosive growth of tele-behavioral health over the last few years, it is considerably less challenging. And as the regulatory environment becomes more welcoming, with the adoption of telemedicine parity legislation inspired by Project ECHO, we can expect this growth trend to continue.

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The biggest potential for tele-behavioral health, however, is not so much in the ambulatory space but in the acute-care setting: Tele-behavioral health can dramatically improve access to psychiatric care in the emergency department, avoid unnecessary transfers and readmissions, reduce patient wait times, and even minimize symptoms of physician burnout.  

These are increasingly important benefits for hospitals and health systems to consider as they create their plans to launch or expand telehealth services.
 

Assessing Behavioral Health Challenges in Acute Facilities

Every acute-care setting is different, but most share the same systemic challenges in addressing patients’ needs—especially behavioral health needs.  

The biggest challenge is addressing the needs of the vast number of patients who need mental health services. An estimated one in five adults in the U.S.—43.8 million—experiences mental illness in a given year. Conversely, the number of primary-care physicians—the professionals who are traditionally the first responders in treating adults with behavioral health needs such as substance abuse and depression—is in steady decline. And according to one recent estimate, 56 percent 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 one study presented at the American College of Emergency Physician’s 2016 meeting revealed, three-quarters of emergency physicians responding to a poll report seeing patients at least once a shift who require hospitalization for psychiatric treatment; almost one-quarter (21 percent) say they have patients waiting two to five days for in-patient beds. A separate but similar 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 being in the emergency department for more than 24 hours.

The number of patients with substance-use disorders seeking immediate medical attention in the ED is particularly troublesome. Sadly, many these individuals hope to obtain opioids or other narcotics, rather than the behavioral health services they need.

However, ED physicians aren’t typically trained to extensively address substance abuse issues—their job is to stabilize, treat, and discharge patients. Additionally, finding qualified staff to address a patient’s behavioral health issues can take hours, which raises their risk for an unfavorable outcome. Patients with substance-abuse issues are notorious for threatening physicians, too. So for some doctors, it might seem easier to deliver a quick fix, such as prescribing an opioid, to buy more time to spend with patients who are experiencing life-threatening emergencies.

As a consequence, long-term behavioral health needs—such as connecting patients to appropriate rehabilitation programs or case managers who oversee ongoing care—are frequently ignored. This can create a vicious cycle, putting patients at greater risk of hospital readmission or an adverse event.
 

Incorporating Tele-behavioral Health

When administered correctly, tele-behavioral health can offer immediate relief and elevate care in acute settings. But it’s important to remember that the virtual consultation is only one aspect of care. In our experience, an acute-care facility will only experience the maximum benefits of tele-behavioral health through the use of a comprehensive, system-wide approach, which uses a telehealth platform that is interoperable with an organization’s existing electronic health record system and other technologies. This approach enables faster, more accurate care and information sharing and better collaboration between multiple providers.

To better understand these benefits at play, it’s helpful to consider some of the more typical behavioral health scenarios in the ED and how system-wide telehealth would enable better care.   

In our first scenario, a 45-year-old man checks himself into the hospital complaining of anxiety, experiencing signs of a panic attack. Upon admission, a triage nurse offers the patient an opportunity to go into a quiet 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, medications, and other factors that contributed to his current state. After assessing the patient’s anxiety at the end of the consultation, the psychiatrist sets up an appointment with a primary-care physician or mental health provider who can consult with him on an ongoing basis. The telehealth consultation then ends and is documented within the same program that hosted the virtual visit, ensuring a smoother transition between care settings.

In our second scenario, a 24-year-old female enters the emergency room complaining of physical pain stemming from long-term injury and demanding opioids. A nurse looks at her medical record and sees that she has a history of repeated ED utilization but no visible injuries. Instead of giving in to the patient’s demands for OxyCodone, the nurse uses the hospital’s telehealth platform to connect with a substance-abuse professional, who can recommend a more appropriate intervention and follow-up.

These are just two acute use cases that demonstrate tele-behavioral health’s vast potential.  There are many more, and the number of successful case studies is growing.

Incorporating tele-behavioral health into acute-care environments can immediately—and meaningfully—improve patient throughput, reduce hospital readmissions, and ultimately change the lives of patients and their loved ones.

Moving forward, organizations would benefit from considering tele-behavioral health’s broader impact on clinical workflows, outcomes, and overall operations. Putting a patient in touch with the right mental health professional as quickly as possible can improve their overall health and ensure acute-care facilities aren’t slowed down in their mission to save lives, one patient at a time.  

Mike Baird is the co-founder and CEO of Avizia, a leading provider of system-wide telehealth.

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