The Use of Telemedicine for Child Psychiatric Consultations in an Inner-city Hospital Puja Desai MD1, Adedotun Adewale1, Matthias Manuel1, Kosha Shah1, Nastasia Nianiaris1, Roy Vega1,2 1 Department of Pediatrics, Bronx Lebanon Hospital Center 2 Department of Emergency Medicine, Bronx Lebanon Hospital Center Background: Similar to other urban hospitals in the United States, the volume and complexities of pediatric psychiatric patients seen in our emergency department has increased tremendously in the last few years. Due to the shortage of mental health care providers in lower socioeconomic areas, patients often have to wait a long time to see a provider. Moreover, most cases of unnecessary hospital admissions occur in settings with limited access to a child Psychiatrist. Telemedicine can potentially bridge this gap. A recent study in San Francisco showed that telemedicine reduced the ED wait time for psychiatric consultations. Aim: To evaluate the impact of telepsychiatry consultation on the length of Pediatric Emergency Department (PED) stay and inpatient admission rates for children with psychiatric conditions. Methods: A retrospective chart review of patients aged 5-21 years who visited our hospital PED from January to December 2016 with conditions necessitating psychiatry consultation. Patients were classified into two groups: those who received telepsychiatry consults (TPC) which occurred between 8 am to 4 pm daily and those who received routine consults (RC) from 4 pm to 8 am daily. Results: There was no difference between the TPC and RC groups in terms of gender, race and disease diagnosis (P=0.248) respectively. Compared to RC, TPC was associated with reduction in admission or transfer to a temporary psychiatric observation unit (OR = 0.42, 95% CI= 0.30, 0.59; p<0.001). After adjusting for differences in age and disease diagnosis, TPC was still associated with reduction in admission rates (OR = 0.41, 95% CI: 0.28, 0.58; p<0.001). A subset analysis of 311 (52%) patients transferred to the temporary psychiatry observation unit from the PED showed that patients who had TPC were less likely to be discharged compared to those who had RC (Adjusted OR=0.49, 95% CI= 0.29,0.84, p=0.010). However, TPC was associated with a longer PED stay compared to RC (183 mins vs. 125 mins; P<0.001). Conclusion: Telemedicine has been proven to improve health care quality in various settings. In our study telemedicine reduced admission rates from the ED and also prevented unnecessary transfers to a temporary psychiatry observation unit. However, there was an increase in ED length of stay. Our results are similar to recent findings published by Center for Medicaid & Medicare Services showing that telemedicine use in nursing facilities reduced unnecessary hospital admissions.
The Use of Telemedicine for Child Psychiatric Consultations in an Inner-city Hospital
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Puja J. Desai, Roy Vega, Adedotun Adewale, Matthias Manuel, Kosha Shah, Nastasia Nianiaris; The Use of Telemedicine for Child Psychiatric Consultations in an Inner-city Hospital. Pediatrics August 2019; 144 (2_MeetingAbstract): 432. 10.1542/peds.144.2MA5.432
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