Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
Psychiatr Q. 2022 Sep;93(3):905-914. doi: 10.1007/s11126-022-10000-z. Epub 2022 Sep 5.
Psychiatry has experienced a rapid expansion in providing behavioral health services using virtual means; however, little is known regarding clinicians' experience in managing patient emergencies during virtual encounters. We present survey data from a large academic psychiatry department designed to better understand safety planning while delivering ambulatory tele-behavioral health services during the COVID-19 pandemic. Clinical faculty in the department were sent an anonymous electronic survey developed and distributed using the Qualtrics™ software. Departmental leadership provided a list of clinicians who performed ambulatory care. SAS 9.4 was used to conduct statistical analysis for associations between variables. Approximately one quarter (23.3%) of respondents engaged in proactive safety planning for most of their outpatient virtual visits, while a little over half (53.2%) of clinicians implemented emergent safety planning between just one to five visits. Clinicians who more frequently implemented emergency protocols were more likely to engage in proactive safety planning prior to emergencies (p = 0.0115). 10.8% of participants petitioned for civil commitment, though those that did identified numerous challenges. Our results reinforce the importance in appropriate training regarding best practices while providing tele-behavioral health care, with increased awareness for conducting safety planning and implementing emergent protocols. Furthermore, while petitioning for civil commitment is a relatively low base rate event in a large outpatient practice, these data and narrative feedback help to outline challenges and potential measures to improve this process for all parties. Increased attention to protocols and procedures are key as the utilization of virtual care within psychiatry continues.
精神病学在通过虚拟手段提供行为健康服务方面经历了快速扩张；然而，对于临床医生在虚拟就诊期间管理患者紧急情况的经验知之甚少。我们展示了来自一个大型学术精神病学部门的调查数据，旨在更好地了解在 COVID-19 大流行期间提供门诊远程行为健康服务时的安全计划。该部门的临床教师收到了一份匿名的电子调查，该调查是使用 Qualtrics™软件开发和分发的。部门领导提供了一份进行门诊护理的临床医生名单。使用 SAS 9.4 对变量之间的关联进行了统计分析。大约四分之一（23.3%）的受访者对他们的大部分门诊虚拟就诊进行了主动安全计划，而略多于一半（53.2%）的临床医生在一到五次就诊之间实施了紧急安全计划。更频繁地实施紧急协议的临床医生更有可能在紧急情况发生之前进行主动安全计划（p = 0.0115）。10.8%的参与者请求民事承诺，但他们确实提出了许多挑战。我们的研究结果强调了在提供远程行为保健护理时适当培训最佳实践的重要性，提高了对安全计划和实施紧急协议的认识。此外，虽然在大型门诊实践中，请求民事承诺的发生率相对较低，但这些数据和叙述性反馈有助于概述挑战，并提出改善所有各方流程的潜在措施。随着精神病学中虚拟护理的使用不断增加，对协议和程序的更多关注是关键。
