CRISIS THROUGH THE SCREEN: VIRTUAL EMERGENCY CARE DURING THE PANDEMIC AND BEYOND

Feuer, Vera; Hoffman, Pamela E.

Objectives: We will address utilization of telepsychiatry in emergency crisis settings. We will review characteristics and results of emergency telepsychiatry programs providing care into controlled healthcare settings and how they pivoted to provide home-based crisis care to families during the stay-at-home orders from the COVID-19 pandemic. Methods: Telepsychiatry has been utilized for years in the emergency department (ED), and its safety, equivalent outcomes compared with face-to-face care, and patient and provider satisfaction have been demonstrated in numerous studies. Public health orders to stay home and local hospital directives to eliminate all nonessential hospital staff resulted in a newly emerging need to utilize and adapt virtual care workflows. We will describe the telepsychiatry services developed and utilized at Children’s Hospital Colorado (CHCO) prior to the start of the COVID-19 pandemic, discussing initial implementation and various adaptations including utilization of home-based providers and room-to-room telepsychiatry (to decrease exposure). We will then review a mixed-methods design study at the Children’s Hospital of Eastern Ontario, Canada, that aimed to evaluate the Emergency Department Virtual Care program that was established during the pandemic to help meet the needs of patients and offer assessments to families in their homes. Finally, we will briefly describe a large hub-and-spoke emergency telepsychiatry program at Northwell Health and will detail rapid transformation of workflows and their adaptations including safety protocols and digital intake processes that were implemented to support safe and efficient home-based care delivery. Results: Telepsychiatry is a well-accepted and feasible modality of care within the emergency setting, even when it is expanded to include care to nonemergency as well as nonclinical environments. Conclusions: Telepsychiatry helps prevent unnecessary ED transfers and visits for patients with mental health needs, which is crucial during a pandemic, and will continue to be beneficial and sustainable beyond. Adaptations for home-based care require a focus on safety protocols, streamlined workflows, and digital tools to enhance the patient experience. TVM, S, RF