TelePsych is an internet-based psychiatric counseling service offered through the Emergency or Acute Care departments of many hospitals. Baylor Scott & White recently implemented TelePsych in a number of its hospital facilities to combat the national and state shortage of psychologists and psychiatrists. The TelePsych population at the Hillcrest facility is most often brought in by law enforcement; once patients are medically cleared they receive a mental health evaluation from social workers in the Emergency Department. The hospital uses a “5 D” protocol to trigger doctors to use TelePsych for a patient: disparity, diagnosis clarity, discharge medication, delay of a transfer (to the next level of care), and discretion of the physician. If it’s decided that TelePsych is the best path and the patient gives permission, then the medical physician and social worker arrange for a TelePsych appointment and brief the psychiatrist. The psychiatrist reviews the patient’s electronic medical records and a designated computer is brought to the patient’s room for the video-streamed consultation. The two have a private conversation of 30 minutes to two hours and the psychiatrist enters recommendations for treatment and/or medication into the patient’s EMR. The attending physician will then prescribe medication if needed and the social worker will start a referral process to transition the patient to the next level of care. There may be supplemental TelePsych visits if the patient is readmitted for an ongoing mental health issue or they stay for inpatient treatment. Most of the time, however, there is no further relationship with the TelePsych psychiatrist after the patient advances to the next level of care.

Baylor Scott & White started TelePsych because many of its hospitals do not have any psychologists or psychiatrists on staff. The Hillcrest hospital in particular has seen an increase in patients needing acute mental health care. Its location next to the highway and the dearth of other trauma centers means that the hospital receives 1-2 patients per day with acute mental health needs. Hillcrest has licensed medical social workers in the Emergency Department but struggled without an actual psychologist or psychiatrist available. Their goal in implementing TelePsych was to move mental health patients through the continuum of care efficiently and with empathy.

The hospital staff at Baylor Scott & White Hillcrest has been very impressed with the implementation and ease of use of the TelePsych process and system. Patient satisfaction has increased and staff are able to move patients through the next level of care more efficiently.

In Hillcrest’s opinion, the TelePsych project has been successful for them. The hospital often had mental health patients in the Emergency Department for days because there was nowhere to admit them or the staff didn’t know where to direct them. With TelePsych they can now get services (medication, treatment, etc.) to the patient much quicker and at the level they need. If a patient needs to move to another facility, Hillcrest does not need to wait for the admitting facility’s doctor to evaluate the patient because he/she has already been seen through TelePsych. Frustration among staff has decreased and patient satisfaction has increased. Patients feel that their issues are acknowledged and can see efforts made to help.