Joe Corbett

Problem Description

Nationwide, access to mental healthcare remains a significant issue, leading to the deterioration of patients' psychiatric conditions. Patients with psychiatric conditions are particularly vulnerable, often facing substantial challenges in social and occupational settings, which reduces their ability to function effectively. Poor access to mental health treatment also negatively impacts physical health (Spurrier et al., 2023). Patients with untreated psychiatric conditions often experience worse physical health outcomes than those receiving treatment (Spurrier et al., 2023). Researchers indicate untreated psychiatric conditions can exacerbate physical health problems, leading to increased morbidity and mortality rates (Spurrier et al., 2023). This situation can result in higher utilization of otherwise preventable emergency department resources (Gurjal, 2022; Theriault et al., 2020).

The problem this quality improvement initiative intended to address is helping resolve issues with mental healthcare access. A telepsychiatric clinic option was added to the care options for patients. The object was to determine if the addition of a tele-psychiatric modality would result in a decrease in emergency department utilization for mental health purposes.

Methods

The QI project focused on psychiatric patients referred to a tele-psychiatric clinic, primarily from suburban and rural areas of central Illinois. Participants were aged 18 and older, with at least one DSM-5-TR psychiatric diagnosis and were evaluated over six months. Data was collected from both in-person and tele-psychiatric consultations. The data was collected on emergency department visits three months before and after admission to the clinic. Data on post-admission to the clinic no-show instances were also gathered. Retrospective data was collected for an inpatient clinic to compare the tele-psychiatric clinic to the in-person clinic.

The Statistical Package for Social Sciences® (SPSS®, 29.0.0, 2022) was used to do statistical analysis. Wilcoxon Signed-Rank Test and Mann-Whitney U Tests were chosen to determine if the results were related to the interventions. These analyses tools effectively accounted for small variations within the datasets and variability errors due to the short three-month pre- and post-consult data collection periods.

Findings

Over a six-month period, data was collected from 110 patients. Analysis revealed the tele-psychiatric clinic led to a reduction in psychiatric-related emergency department hospitalizations. The effect size calculation indicated a moderately significant impact. The data analysis showed the tele-psychiatric clinic had no significant impact on no-show incidents compared to in-person. The effect size calculation indicated insignificant effect.

Practice Implication

The addition of a tele-psychiatric modality clearly had the desired effect of reducing extraneous use of emergency department resources. This has several implications to practice. This quality improvement project demonstrates the implementation of a tele-health modality within the psychiatric realm can greatly improve access to care. This further demonstrated the tele-psychiatric clinic could improve patient outcomes, as noted by decreased incidents of emergency department care.