Lessons Learned on Telehealth in Inpatient Psychiatric Facilities: Quality, Continuity, and Models of Care

Little inpatient telepsychiatry research exists, especially in regard to rural behavioral health services where the need for services far exceeds the number of providers. This case series included 12 inpatients of a non-metropolitan psychiatric hospital treated at a distance for 2 days (i.e., 24 visits) by a remote inpatient psychiatrist utilizing telehealth, who teamed with an on-site resident, medical student, nurse, and social worker. A direct care model was used, remote electronic health record order entry, and documentation for patients with schizophrenia, bipolar disorder, or depressive disorders. Three types of patients were seen: (1) previously seen and followed in person by the same provider, (2) previously admitted with a different provider, and (3) new admissions. Patients consented to telehealth as part of regular care and quality improvement and patient feedback was collected at the end of every session. There were no differences between telehealth and non-telehealth patients in use of emergency medications, codes, and length of stay. Two patients with schizophrenia were too disorganized to go to the tele-interview room; these patients cannot be interviewed on site, either, due to concerns. Patients expressed positive experience with telehealth and no preference for in-person care; all patients seen by the teleprovider preferred this continuity. Telepsychiatry was versatile, was effective, and enabled continuity of care in this small series.