7 questions to answer before implementing telePsychiatry

I felt like I had been hit by a Mack truck,” said Cheryl Chandler when she first saw the now-viral video of her daughter, Rebecca, outside of a Baltimore hospital emergency department on a cold January night. Rebecca, clothed only in a hospital gown and socks, was wheeled out of the emergency room after being treated for an unknown reason and left at a bus stop. The video only tells a fraction of the story, of course, but the images are disturbing—and potentially growing more common.  It is estimated that one in eight patients in the emergency department has a mental health or substance abuse problem.

Many hospitals have turned to telePsychiatry as a way to alleviate overcrowding in the ED. Other hospitals know the status quo is not working, but are unsure if they can afford to implement a telemedicine solution. However, when the full financial picture is analyzed, there are definite cost savings associated with telePsychiatry. SOC helps prospective clients determine the return on their investment by first analyzing more than 20 factors driving costs: patient volume, average length of stay, wait times, security costs for sitters, and many more.

In order to understand your full costs for treating patients in the ED with mental health or substance abuse issues, answer these seven questions:

  1. What percentage of your ED patients have a mental health or substance abuse issue?

And has it increased? Is your overall patient volume predicted to increase? Are other hospitals or clinics in your area going out of business? Are there new partnerships that might increase patient volume? Conversely, if you could treat these patients faster, could you take on more patients overall?

  1. How many hours or days are these patients spending in the ED?

The average wait cost is $2,264 for psychiatric patients (just for the bed). The average boarding time nationwide is 8 to 34 hours. Even on the low end, that time costs an average of $18,000.

  1. What barriers does your ED face to coordinate more timely access to psychiatrists?

Mental health problems occur at all hours of the day. If you have a psychiatrist on staff (increasingly rare), are they available when you need them? If your ED is contracted with one or more mental health practices, is a psychiatrist available 24/7? Or do you need to wait for office hours? And, how far away are they?

  1. Are you finding that your ED frequently needs sitters and/or security?

There is no doubt that mental health patients create risk. More than three-quarters of emergency physicians experience at least one violent incident at work annually, according to the American College of Emergency Physicians. A survey conducted by the Emergency Nurses Association in 2009 found that a quarter of emergency nurses had experienced physical violence more than 20 times in the past three years. Many hospitals hire security guards in the ED at substantial costs.

Hospitals also hire sitters to observe patients who are experiencing mental health issues, such as suicidal or homicidal thoughts.

The cost for security and sitters should also be factored in to any ROI analysis on getting mental health and substance abuse patients through the ED faster.

  1. What is the average wait time for other ED patients and has this time increased in the last two to three years?

In competitive markets, patients have choices in hospitals. If your wait time is too long because your ED is clogged with mental health patients, will other patients choose to go elsewhere for urgent care? And even in communities with only one hospital, will patients bypass the local hospital and travel further, knowing they will be seen faster?

  1. Is there an observed impact on patient satisfaction and ED staff morale?

Employee satisfaction is critical to providing great care. Staff thrive on knowing they are making a difference for patients. When these employees can’t get their mental health patients in front of a psychiatrist for treatment decisions in a timely manner, their job satisfaction can suffer. Patient satisfaction is also a key metric. Whether your hospital is the “only game in town” or competes with multiple area hospitals and urgent care facilities, reputation is important to your revenue stream. What would happen if you had a 5% reduction in other urgent cases? 10%?

  1. How challenging is it for you to effectively recruit and hire psychiatrists?

It is estimated that by 2025, the need for psychiatrists could outstrip supply by as much as 25%. If you are already having challenges in recruiting and hiring psychiatrists, it may be a sign of worse to come. Plus, the costs of onboarding a new psychiatrist include recruiting firms, signing bonuses, relocation expenses and salary guarantees before they ever see the first patient.

TelePsychiatry can help your emergency department evaluate patients more quickly, determine whether they need to be admitted, and discharge them sooner.  Shorter wait times are better for patients, as long waits can make their problems worse. And, freeing up beds in the emergency department for other acute patients can increase revenue.

If you are planning on implementing telePsychiatry in your hospital, and would like to discuss a custom ROI analysis from SOC, please let us know.