Lessons Learned in Creation and Maintenance of Telemedicine Services for C-L and Emergency Psychiatry Coverage in Diverse Multiple Hospital Systems. Sponsored by ACLP's Telepsychiatry SIG

The five presenters will describe integrated telemedicine-based consultation-liaison services which provide ‎services to multiple facilities within integrated care systems. Each speaker will provide an overview of ‎clinical services, describe challenges in service line development, staffing models, and plans for expansion. ‎Challenges (e.g., staffing, team communication, stakeholder preparedness, performance metrics) will be ‎addressed with proposed solutions. Opportunities (e.g., enhancing quality, scholarly activity, peer ‎consultation, peer review) found in this model will be addressed for dissemination. Speakers will then lead ‎breakout sessions after which attendees will interact with the speakers as a panel.‎

Dr. Alkis: MUSC telehealth inpatient consultation-liaison service serves 9 inpatient facilities across SC. ‎Many facilities are MUSC-affiliated, while others are collaborations with facilities who do not have in-‎house psychiatrists. The Tele C-L service sees admitted patients. SC Department of Mental Health ‎psychiatrists see patients in Emergency Departments that do not have access to in-person psychiatrists.‎

Dr. Foster: HCA Telehealth Provider Plus provides services to emergency rooms and inpatient units across a ‎large private healthcare corporation. The service initially covered only ERs in West Florida; it later ‎expanded to ERs and medical floors in North Florida, covering 23 sites from Tallahassee to Sarasota with ‎clinicians from an outside telehealth firm and company-hired psychiatrists.‎

Dr. Marshalek: WVU telemedicine covers multiple critical access hospitals throughout WV, providing ‎consults to medical units and EDs for adults and children. Three service lines include a general academic ‎teaching service, dedicated substance use disorder service, and an ED service. There is a "psych command ‎center" coupled with a bed board. This addition facilitates standardization of practices across multiple ‎sites.‎

Dr. Finn: Dartmouth-Health TelePsychiatry provides 24/7 access to psychiatric consultation for patients of ‎all ages. Consultations occur in the ED or inpatient settings, in 14 hospitals (both health system affiliates ‎and not) in NH and VT. Hospitals are located in both rural and suburban settings and have a high degree of ‎variability in their internal and surrounding community mental health resources. This makes access to ‎timely psychiatric consultation highly impactful to clinical care and disposition determinations.‎

Dr. Bourgeois BSWH initiated a hospital telepsychiatry service to cover 26 BSWH hospitals in TX, ‎administered by the academic medical center in Temple. There are 7 physicians, including 2 CAP and 1 ‎geriatric subspecialist. Shifts have 2 or 3 psychiatrists on duty. Consults and secure messaging are done ‎within the Epic system. This service has had a significant impact on ED length of stay (LOS) and sitter hours.‎

References
‎1. Abrams J, Sossong S, Schwamm LH, et al. Practical issues in delivery of clinician-to-patient telemental ‎health in an academic medical center. Harv Rev Psychiatry. 2017;25(3):135-145.‎
‎2. Graziane JA, Gopalan P, Cahalane J. Telepsychiatry consultation for medical and surgical inpatient units. ‎Psychosomatics. 2018;59(1):62-66.‎
‎3. Shayevitz C, Breitinger S, Lerario MP, et al. Implementation of a centralized telepsychiatry consult ‎service in a multi-hospital metropolitan health care system: challenges and opportunities. J Acad Consult ‎Liaison Psychiatry. 2021;62(2):193-200.‎