How telebehavioral healthcare can improve ED operations

Turning to telebehavioral health in the ED

Franciscan Health Olympia Fields has seen a rise in need for behavioral healthcare in its EDs, Derwin Phillip, M.D., medical director and chairman of the department of emergency medicine for Franciscan Health Olympia Fields, shared in a recent interview.

Socioeconomic stressors have skyrocketed in recent years, between a once-in-a-century pandemic and ongoing political and economic upheaval. Additionally, there is an increased awareness around mental healthcare. While this is a positive shift, the growing shortage of mental health professionals is leading patients to the ED for mental healthcare.

To more effectively meet the demand for mental healthcare in the ED, Franciscan Health Olympia Fields joined forces with Array Behavioral Care, a telepsychiatry provider.

"It really came about because the gap was identified that having the resources to offer mental health services 24/7 was somewhat of a barrier at Franciscan Health Olympia Fields," said Phillip. "Without that, we had some resources using social workers, but there was a defined period when they were not accessible to us. So, it limited the scope of services that could be provided, and we felt that expanding the services and having the capability of telepsychiatrists being accessible to us would be a benefit."

In 2023, the hospital received a federal grant to launch the telebehavioral health program within its ED.

Exploring the telebehavioral health program

The primary purpose of the telebehavioral health program at the Olympia Fields hospital ED is to connect patients with psychiatric expertise in a timely manner.

For instance, someone might come into the emergency department with an acute behavioral health problem, such as substance abuse or suicidality, requiring an expert psychiatric assessment, explained Sara Gotheridge, M.D., psychiatrist and chief medical officer at Array Behavioral Care.

After being evaluated by the Olympia Fields hospital ED staff, the patient is connected to Array's behavioral health specialists for a psychiatric evaluation via a tablet or computer.

"At the same time, we're using Franciscan's EMR and our own technology systems to see if that person has a history with the hospital, if they've been to Franciscan before -- what do we know about them, what has happened with their workup in the ED?" Gotheridge said. "And then we make a recommendation directly to the Franciscan team."

That recommendation could be that the patient is suitable for discharge, requires follow-up behavioral healthcare or needs to be admitted for inpatient care. The Array team also assists with medication management.

According to Gotheridge, Array clinicians primarily focus on risk stratification, examining risk indicators and making an informed decision about whether the patient can be discharged.

"We also employ very extensive safety planning for someone who's being discharged -- talking to families, getting a better picture of what's going on with someone, assessing for firearm safety -- that's very, very important," she said.

Impact of the program on ED operations

The telebehavioral health program has significantly improved timely management of behavioral health needs in the ED.

Joan Culver, chief nursing officer/interim vice president of patient care services for Franciscan Health Olympia Fields, shared that being able to connect patients with Array streamlines mental health evaluations, allowing ED clinicians to make a decision about the patient's next step faster. 

"We're really looking at that turnaround time to see how quickly we can get them assessed and help clinicians make a determination so that we can have an outcome for them," she said. "So, that is a really important piece of the puzzle for us because it helps us determine how quickly we can get them to the next stage of their journey and help them find relief."

The program cuts down time lag in providing behavioral healthcare in the ED by offering 24/7 access to behavioral health specialists.

"We had limited onsite psychiatrists who were available by phone [or in-person]," Phillip said.  "And so that period, that time lag, was also a contributor to inefficiency of the process before, leading to dissatisfaction among providers, patients, patients' families with the length of time it took to get the consult with the specialists."

This easy and convenient access to behavioral health expertise is a key benefit for clinicians.

Phillip explained that ED physicians rely on consultations with specialists to provide high-quality care. Array enables physicians to access that specialty expertise, supporting a teamwork approach to care, where the onus is not solely on the ED provider to do the assessment and make the determination.

Culver agreed, adding that the program is also a great resource for ED nurses.

"The program provides some relief for our providers as well as for our nursing and our other care team members, knowing that we have that specialist at our fingertips, so to speak," she said.

Ultimately the Olympia Fields hospital ED is better equipped to streamline patient flow and increase ED capacity, allowing for more patients to access emergency care, Phillip highlighted.

Although getting clinicians acclimated to the new telebehavioral health process took some time, hospital leaders noted that the implementation was seamless overall. According to Gotheridge, collaboration between the hospital and Array was a critical factor in ensuring a smooth deployment.

"It really is the key," she said. "Every setting that we work with across the country is a little bit different. The needs are different. The population, the places served are different. And in behavioral health -- this is probably more true than any other field in healthcare -- handoffs just do have to be seamless."

This is why Array clinicians have insight into the patient's medical history and any previous visits to the Franciscan facility. Additionally, Array leaders have gone to the hospital to understand the ED workflow and where their telepsychiatrists will fit in, Gotheridge said.

Armed with convenient access to behavioral health expertise, Franciscan Health Olympia Fields clinicians are seeing improvements in ED operations, resulting in better patient care and experiences. 

"Anybody who's ever been a patient in an emergency department, those are the things you want: you want to have a good quality outcome, you want to make sure you're seen in a timely manner, you want to make sure you have answers," Culver said. "And for these patients, the program is probably one of the best things that we can provide for them -- an answer in a timely fashion."

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Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.