Independent and joint associations between patient characteristics and the triaging process for a telepsychiatry...

Telepsychiatry is vital to mental health care delivery in acute care settings. This study aimed to characterize the demographic and clinical factors associated with psychiatric consult triage in the general hospital setting for a telepsychiatry consultation-liaison service.

We conducted a retrospective cohort study of patients receiving psychiatric consultations at two New York City hospitals. Independent associations between patient characteristics and the binary triage outcome of teleconsult versus in-person evaluation were summarized, and joint associations were studied using logistic regression with least absolute shrinkage and selection operator (LASSO). Separate analyses were performed for the emergency department (ED) and inpatient settings.

A total of 3503 patient visits were analyzed between 2018 and 2021. For ED patients, Richmond Agitation-Sedation Scale (RASS) scores of +1 or ≤ -1 were negatively associated with teleconsult, suggesting that those patients required more hands-on care. Anxiety or depressed consult reason, and diagnoses of bipolar disorder, schizophrenia spectrum disorder, and suicidal ideation/attempt/self-harm were positively associated with teleconsult, indicating that virtual assessment was suitable. For the inpatient cohort, all non-zero RASS scores were negatively associated with teleconsult, while diagnoses of bipolar, depressive, schizophrenia spectrum, and substance use disorders were positively associated.

This is the first study to delineate specific clinical indicators guiding triage in a hybrid telepsychiatry consult service model. RASS score emerged as the most clinically actionable metric, offering a scalable, efficient tool to support rapid triage. Our findings also reinforce that a broad range of psychiatric presentations can be effectively managed via telepsychiatry in acute medical settings.