National study of telepsychiatry use in U.S. Emergency departments

Abstract

Objective: The receipt of telemedicine for the management of mental illness, also known as telepsychiatry, is being adopted in emergency departments (EDs), but little is known about this approach. This study investigated the prevalence and applications of telepsychiatry in general EDs in the United States. Methods: All 5,375 U.S. EDs were surveyed to characterize emergency care in 2016. From the EDs that reported receiving telepsychiatry services, a 15% random sample was selected for a second survey that confirmed telepsychiatry use in 2017 and collected data on emergency psychiatric services and applications of telepsychiatry in each ED. Results: The 2016 national survey (4,507 of 5,375; 84% response) showed that 885 (20%) EDs reported receiving telepsychiatry. Characteristics associated with higher likelihood of ED telepsychiatry receipt included higher annual total visit volumes, rural location, and Critical Access Hospital designation. Characteristics associated with lower likelihood of telepsychiatry receipt included being an autonomous freestanding ED. In the second survey (105 of 130; 81% response), 95 (90%) EDs confirmed telepsychiatry use. Most (59%) of these reported telepsychiatry as their ED's only form of emergency psychiatric services, and 25% received services at least once a day. The most common applications of telepsychiatry were in admission or discharge decisions (80%) and transfer coordination (76%). Conclusions: In 2016, 20% of EDs received telepsychiatry services, and most receiving telepsychiatry had no other emergency psychiatric services. The latter finding suggests that telepsychiatry is used to fill a critical need. Further studies are warranted to investigate barriers to implementing telepsychiatry in EDs without access to emergency psychiatric services.