JMIR Publications

ABSTRACT

Background:

Telepsychiatry (TP), a live video meeting, has been implemented in many contexts and settings. It has a distinct advantage in the psychiatric emergency department (ED) setting, as it expedites expert assessments for psychiatric patients. However, limited knowledge exits of TP effectiveness in the ED setting, as well as the process of implementing TP in this setting.

Objective:

This scoping review aimed to review the existing evidence for the administrative and clinical outcomes for TP in the ED setting, and to identify the barriers and facilitators to implementing TP in this setting.

Methods:

The scoping review was conducted according to the guidelines for the PRISMA-ScR (Preferred Reporting Item for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Three electronic databases were examined: PubMed, Embase, and Web of Science. The databases were searched from January 2013 to April 2023 for papers and their bibliography. A total of 2,816 potentially relevant papers were retrieved from the initial search. Studies were screened and selected independently by two authors.

Results:

A total of 11 articles were included. 10 papers reported on administrative and/or clinical outcomes of TP use in the ED setting, and one on the barriers and facilitators of its implementation. TP is used in urban and rural areas, and for settings with and without on-site psychiatric services. Evidence shows TP reduced waiting time for psychiatric evaluation, but in some studies was associated with prolonged total length of stay in the ED compared with in-person evaluation. Conflicting findings were found regarding the effect of TP on admission rates for patients evaluated in the ED. Limited data were reported for TP costs, its use for involuntary commitment evaluations, and its use for particular subgroups of patients (e.g., those with a particular diagnosis). A single paper examined TP implementation process in the ED, which explored the barriers and facilitators for implementation among patients and staff in a rural setting.

Conclusions:

Based on the extant studies, TP seems to be generally feasible and acceptable to key stakeholders. However, this review detected a gap in the literature regarding TP's effectiveness and implementation process in the ED setting. Specific attention should be given to the examination of this service for specific groups of patients, as well as its use to enable assessments for possible involuntary commitment.