Psychiatric Emergency
Conditions
Keywords
telepsychiatry, implementation science
Brief summary
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: 1. The intervention will result in shorter ED time compared to historical controls. 2. The intervention will result in fewer violent incidents compared to historical controls. 3. The intervention will result in shorter overall hospital length of stay compared to historical controls.
Interventions
OTHERTelepsychiatry
Instead of coming to the hospital physically, the attending psychiatrist will evaluate the patient via a video-link.
Sponsors
Hebrew University of Jerusalem
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
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)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| ED Time | 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. | Amount of time, in hours and minutes, that the patient spends in the ED prior to disposition |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Violent Incidents | 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. | Adjudicated violent incidents that occur, whether in the ED or on the psychiatry ward. Includes hitting, kicking, throwing, and property destruction |
| Hospital Length of Stay | 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. | Length of stay, in days, starting with time of arrival to ED |
Countries
Israel
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Pre-Innovation (Usual Care) 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. | 525 |
| Innovation (Tele-Psychiatry) 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.
Telepsychiatry: Instead of coming to the hospital physically, the attending psychiatrist will evaluate the patient via a video-link. | 434 |
| Total | 959 |
Baseline characteristics
| Characteristic | Pre-Innovation (Usual Care) | Innovation (Tele-Psychiatry) | Total |
|---|---|---|---|
| Age, Customized Age 18-33 | 226 Participants | 205 Participants | 431 Participants |
| Age, Customized Age 34-50 | 175 Participants | 129 Participants | 304 Participants |
| Age, Customized Age 51-68 | 88 Participants | 76 Participants | 164 Participants |
| Age, Customized Age 69+ | 36 Participants | 24 Participants | 60 Participants |
| Race/Ethnicity, Customized Arab | 76 Participants | 56 Participants | 132 Participants |
| Race/Ethnicity, Customized Foreign Workers or Tourists | 6 Participants | 1 Participants | 7 Participants |
| Race/Ethnicity, Customized Jewish | 443 Participants | 377 Participants | 820 Participants |
| Region of Enrollment Israel | 525 participants | 434 participants | 959 participants |
| Sex: Female, Male Female | 203 Participants | 161 Participants | 364 Participants |
| Sex: Female, Male Male | 322 Participants | 273 Participants | 595 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 525 | 0 / 434 |
| other Total, other adverse events | 0 / 525 | 0 / 434 |
| serious Total, serious adverse events | 0 / 525 | 0 / 434 |
Outcome results
Primary
ED Time
Amount of time, in hours and minutes, that the patient spends in the ED prior to disposition
Time frame: 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.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pre-Innovation (Usual Care) | ED Time | 106 Minutes |
| Innovation (Tele-Psychiatry) | ED Time | 103 Minutes |
Secondary
Hospital Length of Stay
Length of stay, in days, starting with time of arrival to ED
Time frame: 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.
Population: Only those who were admitted to hospital; does not include those discharged from the Emergency Department
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pre-Innovation (Usual Care) | Hospital Length of Stay | 18 days |
| Innovation (Tele-Psychiatry) | Hospital Length of Stay | 23 days |
Secondary
Violent Incidents
Adjudicated violent incidents that occur, whether in the ED or on the psychiatry ward. Includes hitting, kicking, throwing, and property destruction
Time frame: 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.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Innovation (Usual Care) | Violent Incidents | 108 Participants |
| Innovation (Tele-Psychiatry) | Violent Incidents | 96 Participants |