Inspira Health Network, a nonprofit, three-hospital health system serving communities across southern New Jersey, lacked psychiatric providers, resulting in delays in service. Consults have a 24-hour window, which led to bed, intervention and recommendation delays for medical patients.
As a result, it was not unusual for patients to wait longer than 24 hours for psychiatric consults due to a lack of available psychiatrists. Because many patients were accessing services through the emergency department, this protracted wait period created bottlenecks and bed delays. In addition, needed psychiatric interventions and medication therapies were delayed that could help stabilize patient conditions as emergency department staff waited on the direction of specialists with the right expertise.
Inspira Health Network chose to work with the Center for Family Guidance and its sister company, InSight Telepsychiatry, a national service provider that aims to improve access to behavioral healthcare through telehealth technology.
“We opted to use telepsychiatry for psychiatric consultation of medical inpatients to promote efficiency, access and throughput,” said Sarah Seabrook-DeJong, RN, director of psychiatry services at Inspira Health Network. “The expectation was that around-the-clock, real-time access to psychiatric resources would improve patient throughput and speed care delivery processes.”
Patients would receive needed interventions quicker, resulting in better outcomes and higher levels of satisfaction, she explained. The new technology-enabled process would also create workflow efficiencies and lend to less bottleneck in the emergency department, ultimately improving the hospitals’ bottom line, she added.
In addition, around-the-clock access to psychiatric consults would improve provider satisfaction as patients would receive high quality, “whole person” care in a timely manner, said Seabrook DeJong.
“This would allow for 24/7 access to a psychiatrist through a remote video conferencing model, which would promote interventions, recommendations and dispositions to transpire much more quickly and effectively,” she explained.
There are many vendors on the market today offering telemedicine technology, including American Well, Avizia, GlobalMed, MDLive, Novotalk, SnapMD, Teladoc, TeleHealth Services, Tellus and Tyto Care.
MEETING THE CHALLENGE
Inspira Health provided iPads on mobile carts and a Bluetooth speaker that go directly to a patient’s bedside for a consultation. This new workflow was designed to address inpatient admissions going to the medical floors at two of Inspira’s hospitals. While the system does not currently offer inpatient psychiatric services, some patients require psychiatric consultation prior to leaving the emergency department.
“The telepsychiatry iPad is managed by the nursing supervisor, who deploys the cart when requested,” said Seabrook-de Jong. “The consultation with the patient is monitored by either a medical technician or nurse to ensure patient safety while not affecting confidentiality.”
The telepsychiatry system is a separate, HIPAA-compliant app with the telepsychiatrists documenting directly into Inspira’s EHR. The telepsychiatry service is integrated with Inspira’s Cerner EHR. InSight’s telepsychiatrists document into Cerner, improving workflow efficiencies and allowing information to be shared in near-real time, she said.
“By creating a clear, efficient process, modeled after an existing one for teleneurology, staff were educated on the flow and steps to accomplish a consistent experience and expectation for patients,” she explained. “Having a designated liaison between Inspira Health Network and InSight telepsychiatry was critical to the success of the innovative technology and new process.”
Inspira Health has seen response times around two hours from request of consult to completion of the assessment. It is able to secure a disposition from a specialist, enabling the hospital attendings to determine treatment care directives, consideration of psychiatric admission, discharge, initiation of effective psychotropics, and more.
“Nearly 100 percent of behavioral health consults are now completed through the telepsychiatry provider,” said Seabrook-de Jong. “Only in rare cases are alternative options employed. For instance, a face-to-face consult was ordered for a deaf patient who used a hearing device. This new technology-enabled approach to care processes has allowed us to substantially reduce wait times and improve throughput.”
Notably, pushback from medical staff has been minimal, she added.
“Hospital physicians appreciate having near-real-time access to psychiatric consult information and the fact that patients receive interventions in a timelier fashion,” she said. “The fact that all staff are agreeable to this change speaks to the initiative’s success.”
This model was so successful in its initial implementations that Inspira Health Network has selected it for their newest hospital, to open in November 2019, as it fits the future needs and use of technology perfectly, she said.