JMIR Publications

ABSTRACT

Background:

Telepsychiatry is the use of virtual communication such as video-link in delivering mental health assessment, treatment, and follow-up. Although this method is feasible, effective, and accurate, most previous studies have focused on using telepsychiatry in community settings, and not for involuntary admission.

Objective:

The aim of this study is to examine the effectiveness and the implementation process of patient assessment for involuntary admissions in the psychiatric Emergency Department (ED) using video-link.

Methods:

This is a hybrid implementation study, Type 1, which will examine telepsychiatry effectiveness and its implementation process in the ED. The study will evaluate the use of telepsychiatry (n=240) compared to historical controls of face-to-face evaluation (n=240) in five psychiatric EDs in Israel. A temporary waiver of the standing policy requiring in-person evaluations only, for the purpose of research, was obtained from the Israeli Ministry of Health. During the telepsychiatry phase, clinical staff and patients will join a video-call from the ED, while the attending physician will log-in elsewhere. This will be compared to historical data from the previous, usual-care period.

Results:

Primary clinical outcomes will include ED length of stay and violent incidents, obtained from medical records. Data collection for implementation outcomes will be guided by the Promoting Action on Research Implementation in Health Services (PARIHS) framework and include three constructs: 1) Evidence- staff perceptions of the strength and feasibility of telepsychiatry, and psychiatric and patients' satisfaction with the ED work/course; 2) Context- acceptability of initiatives in the ED, the way decisions are made, and the way clinical teams are communicating and collaborating; 3) Facilitation- adequacy of the facilitation efforts using champions reports.

Conclusions:

Telepsychiatry could have significant benefits for patients in the psychiatric ED. Identifying the facilitators and barriers of implementing telepsychiatry in different emergency settings will facilitate better policy decisions regarding its implementation. Clinical Trial: ClinicalTrials.gov registration, NCT05771545.