title: Telemental health evaluations enhance access and efficiency in a critical access hospital emergency department.
abstract: BACKGROUND
  Mentally ill patients in crisis presenting to critical access hospital emergency rooms often face exorbitant wait times to be evaluated by a trained mental health provider. Patients may be discharged from the hospital before receiving an evaluation or boarded in a hospital bed for observation, reducing quality and increasing costs. This study examined the effectiveness of an emergency telemental health evaluation service implemented in a rural hospital emergency room.
  
  
  METHODS
  Retrospective data collection was implemented to consider patients presenting to the emergency room for 212 days prior to telemedicine interventions and for 184 days after. The study compared measures of time to treatment, length of stay (regardless of inpatient or outpatient status), and door-to-consult time.
  
  
  RESULTS
  There were 24 patients seen before telemedicine was implemented and 38 seen using telemedicine. All patients had a mental health evaluation ordered by a physician and completed by a mental health specialist. Significant reductions in all three time measures were observed. Mean and median times to consult were reduced from 16.2 h (standard deviation=13.2 h) and 14.2 h, respectively, to 5.4 h (standard deviation =6.4 h) and 2.6 h. Similar reductions in length of stay and door-to-consult times were observed. By t tests, use of telemedicine was associated with a statistically significant reduction in all three outcome measures.
  
  
  CONCLUSIONS
  Telemedicine appears to be an effective intervention for mentally ill patients by providing more timely access to mental health evaluations in rural hospital emergency departments.
authors.affiliation: 1 Department of Advanced Practice Nursing, Indiana State University , Terre Haute, Indiana.
authors.forename: Erik P
authors.initials: EP
authors.lastname: Southard
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Neufeld
authors.forename: Stephanie
authors.initials: S
authors.lastname: Laws
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003419:Crisis Intervention / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D019114:Remote Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012424:Rural Population; D012720:Severity of Illness Index; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: business administration/economics; telehealth; telemedicine; telepsychiatry