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The Use of Telepsychiatry to Provide Cost-Efficient Care During Pediatric Mental Health Emergencies
John F Thomas1, Douglas K Novins1, Patrick W Hosokawa1
1Except for Ms. Hunter and Mr. Frunzi, the authors are with the University of Colorado School of Medicine, Aurora. Dr. Thomas and Dr. Novins are with the Department of Psychiatry, Mr. Hosokawa is with the Adult and Child Consortium for Outcomes Research and Dissemination Science, Dr. Olson and Dr. Brent are with the Department of Pediatrics, and Dr. Libby is with the Department of Emergency Medicine. Dr. Thomas and Dr. Olson are also with the Department of Telemedicine, where Ms. Hunter and Mr. Frunzi are affiliated, and Dr. Novins is also with the Pediatric Mental Health Institute, all at Children's Hospital Colorado, Aurora.
Objective:
This study evaluated a videoconference-based psychiatric emergency consultation program (telepsychiatry) at geographically dispersed emergency department (ED) sites that are part of the network of care of an academic children's hospital system. The study compared program outcomes with those of usual care involving ambulance transport to the hospital for in-person psychiatric emergency consultation prior to disposition to inpatient care or discharge home.
Methods:
This study compared process outcomes in a cross-sectional, pre-post design at five network-of-care sites before and after systemwide implementation of telepsychiatry consultation in 2015. Clinical records on 494 pediatric psychiatric emergencies included ED length of stay, disposition/discharge, and hospital system charges. Satisfaction surveys regarding telepsychiatry consultations were completed by providers and parents or guardians.
Results:
Compared with children who received usual care, children who received telepsychiatry consultations had significantly shorter median ED lengths of stay (5.5 hours and 8.3 hours, respectively, p<.001) and lower total patient charges ($3,493 and $8,611, p<.001). Providers and patient caregivers reported high satisfaction with overall acceptability, effectiveness, and efficiency of telepsychiatry. No safety concerns were indicated based on readmissions within 72 hours in either treatment condition.
Conclusions:
Measured by charges and time, telepsychiatry consultations for pediatric psychiatric emergencies were cost-efficient from a hospital system perspective compared with usual care consisting of ambulance transport for in-person consultation at a children's hospital main campus. Telepsychiatry also improved clinical and operational efficiency and patient and family experience, and it showed promise for increasing access to other specialized health care needs.