Telepsychiatry to Enable Expedited Disposition of Psychiatric Emergencies

Study Overview
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Brief Summary
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The goal of this observational study is to examine the effect of using a video link for evaluation of patients in the psychiatric emergency room. Under current Israeli law, the attending physician must come in to physically examine the patient before they can be admitted involuntarily. Patients often de-compensate and even may become violent while waiting for the attending to arrive. Previous studies have shown that evaluation of such patients via video-link has an extremely high concordance with in person evaluation. This study will compare patients who are evaluated via video-link with historical controls evaluated under usual conditions. This is an observational study, which is taking advantage of a change in practice to collect data on two different ways of delivering care, via chart reviews. If successful, this study will show that the video-link is feasible and acceptable to patients and staff. The following hypotheses will be tested: The intervention will result in shorter ED time compared to historical controls. The intervention will result in fewer violent incidents compared to historical controls. The intervention will result in shorter overall hospital length of stay compared to historical controls.

Official Title
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Telepsychiatry to Enable Expedited Disposition of Psychiatric Emergencies

Conditions
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Psychiatric Emergency

Intervention / Treatment
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* Other: Telepsychiatry


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Must be evaluated in the psychiatric ED for potential involuntary admission Exclusion Criteria: Not justice-involved (i.e., brought in by police after committing a crime)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Pre-Innovation (Usual Care)<br>Patients evaluated in the psychiatric emergency department for possible involuntary admission during the year prior to the innovation in care. During this period, the attending psychiatrist was required to physically come to the hospital to examine the patient. | |
| Innovation (Tele-Psychiatry)<br>Patients evaluated in the psychiatric emergency department for possible involuntary admission during the innovation period. Instead of physically coming to the hospital, the attending physician will evaluate the patient via video-link, which will be facilitated by the on-site psychiatric resident. | Other: Telepsychiatry<br>* Instead of coming to the hospital physically, the attending psychiatrist will evaluate the patient via a video-link.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ED Time | Amount of time, in hours and minutes, that the patient spends in the ED prior to disposition | Patients arrive in the ED at a specific time and leave the ED at a specific time. We will compute the amount of time spent in the ED by each patient, up to two weeks. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Violent Incidents | Adjudicated violent incidents that occur, whether in the ED or on the psychiatry ward. Includes hitting, kicking, throwing, and property destruction | Patients arrive in the ED at a specific time. Those who are admitted are eventually discharged. Violent incidents can occur during the entire time spent in the hospital, whether in the ED or on the ward, up to 90 days total. | 
| Hospital Length of Stay | Length of stay, in days, starting with time of arrival to ED | For patients admitted to the hospital through the ED, the beginning time is their arrival to ED, the end is the time of hospital discharge, up to 90 days later. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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telepsychiatry, implementation science