Department of Psychiatry and Behavioral Medicine, Brody School of Medicine, Greenville, North Carolina (Kothadia, Saeed, Torres); Department of Public Health, East Carolina University, Greenville, North Carolina (Jones).
Psychiatr Serv. 2020 Dec 1;71(12):1239-1244. doi: 10.1176/appi.ps.201900431. Epub 2020 Oct 6.
The number of patients seeking treatment in emergency departments (EDs) for mental health reasons is rising, and these patients are often kept in the ED until they can be treated or discharged, leading to overcrowding. Telepsychiatry may alleviate overcrowding by increasing the rate of discharges home.
ED discharge records for 86,931 patients with psychiatric symptoms were examined to compare patient disposition and length of stay (LOS) between times when the North Carolina Statewide Telepsychiatry Program (NC-STeP) program was available or unavailable.
For patients with a LOS of >2 days (N=3,144) and when NC-STeP was available, 62% (N=1,941) were discharged home, and 29% (N=922) were transferred to a psychiatric facility. When NC-STeP was unavailable (N=2,662), 43% (N=1,139) of these patients were discharged home, and 46% (N=1,230) were transferred to a psychiatric facility. For patients with a LOS of 1-2 days and when NC-STeP was available (N=41,713), 77.0% (N=32,131) were discharged home, and 15.4% (N=6,441) were transferred to a psychiatric facility, compared with 74.2% (N=29,237) discharged home and 13.9% (N=5,495) transferred to a psychiatric facility when NC-STeP was unavailable (N=39,412). The increases in discharges home and decreases in referrals to psychiatric facilities when NC-STeP was available were statistically significant for patients in both groups (p<0.001).
Results suggest that telepsychiatry programs such as NC-STeP increase the number of discharges home and decrease transfers to psychiatric facilities, likely promoting patient satisfaction and improving ED efficiency.
因心理健康问题到急诊部（ED）就诊的患者人数不断增加，这些患者通常在 ED 接受治疗或出院，导致人员拥挤。远程精神病学可通过提高出院回家的比例来缓解过度拥挤。
检查了 86931 名有精神症状的患者的 ED 出院记录，以比较在北卡罗来纳州远程精神病学计划（NC-STeP）可用和不可用时患者的处置方式和住院时间（LOS）。
对于 LOS >2 天的患者（N=3144），并且 NC-STeP 可用时，62%（N=1941）出院回家，29%（N=922）转至精神病院。当 NC-STeP 不可用时（N=2662），43%（N=1139）的这些患者出院回家，46%（N=1230）转至精神病院。对于 LOS 为 1-2 天且 NC-STeP 可用的患者（N=41713），77.0%（N=32131）出院回家，15.4%（N=6441）转至精神病院，而 NC-STeP 不可用时，74.2%（N=29237）出院回家，13.9%（N=5495）转至精神病院（N=39412）。当 NC-STeP 可用时，两组患者的出院回家比例增加，转至精神病院的比例下降，这一结果具有统计学意义（p<0.001）。
结果表明，像 NC-STeP 这样的远程精神病学计划可以增加出院回家的人数，减少转至精神病院的人数，可能会提高患者满意度并提高 ED 效率。
