Something akin to a medical Skype has dramatically reduced the time mental health patients at KentuckyOne Health-St. Joseph Berea languish undiagnosed in the emergency room.
"When patients have a crisis they come at all hours," said Darcy Maupin, the hospital's emergency department manager. Those in crisis may be suffering from accidental overdose, suicide attempts, untreated mental illness, drug withdrawal or a "broad spectrum of disorders," said Maupin.
Traditionally, it was difficult to get the psych patients an expert evaluation overnight and during the hours outside of typical office hours, she said. Even during regular daytime hours getting an evaluation could take at least an hour — a time frequently extended by interstate backups— as trained staff traveled from Lexington and sometimes Louisville.
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Now, Maupin said, with telemedicine innovation and a secure video transmission line, an evaluation can take place in as little as 15 minutes. That means treatment can begin, or if inpatient care is needed, the search for an available hospital bed can be underway, much sooner.
"It's been a big help for us," she said.
The difference is a result of a telehealth initiative begun at St. Joseph Berea and three other KentuckyOne hospitals in May of 2014, said Martha Mather, chief operating officer at Our Lady of Peace, a Louisville psychiatric hospital.
The process works like this: A team at Our Lady of Peace is alerted to a patient in need of an evaluation. An evaluator is assigned, a staff psychiatrist in Louisville is consulted and video equipment specially designed to keep patient information confidential is put into use.
At Our Lady of Peace, the evaluator sits in front of a monitor. At Berea, a monitor is rolled into a patient's room to provide privacy.
At first, Maupin was hesitant about how patients in crisis might accept the technology, she said.
"We kind of entered it with a little bit of trepidation," she said.
But most people interact all the time with screens, so patients have been very receptive, she said.
There are exceptions to the use of the telehealth evaluation, said Mather. Patients who are actively psychotic will not be evaluated through the program. People severely impaired because of drugs or alcohol are also not good candidates, she said.
Of the 290 patients evaluated in the four pilot hospital programs, about 66 percent needed to be hospitalized, she said.
Interacting via monitor means that the evaluator is more tuned into the person in front of them, watching for non-verbal cues that could be helpful in determining appropriate treatment, she said.
Being able to diagnose these patients quickly helps the emergency room overall, she said.
"It takes that person out of the queue as other folks are coming in with acute medical needs," she said.
The basic technology involved, Mather said, is fairly simple but the program has "exceeded our expectations."