School of Public Health, Hebrew University, Jerusalem, Israel.
Psychiatric Division, Sourasky Medical Center, Tel Aviv-Yafo, Israel.
J Med Internet Res. 2024 Jul 15;26:e51814. doi: 10.2196/51814.
Telepsychiatry (TP), a live video meeting, has been implemented in many contexts and settings. It has a distinct advantage in the psychiatric emergency department (ED) setting, as it expedites expert assessments for psychiatric patients. However, limited knowledge exits for TP's effectiveness in the ED setting, as well as the process of implementing TP in this setting.
This scoping review aimed to review the existing evidence for the administrative and clinical outcomes for TP in the ED setting and to identify the barriers and facilitators to implementing TP in this setting.
The scoping review was conducted according to the guidelines for the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Three electronic databases were examined: PubMed, Embase, and Web of Science. The databases were searched from January 2013 to April 2023 for papers and their bibliography. A total of 2816 potentially relevant papers were retrieved from the initial search. Studies were screened and selected independently by 2 authors.
A total of 11 articles were included. Ten papers reported on administrative and clinical outcomes of TP use in the ED setting and 1 on the barriers and facilitators of its implementation. TP is used in urban and rural areas and for settings with and with no on-site psychiatric services. Evidence shows that TP reduced waiting time for psychiatric evaluation, but in some studies, it was associated with prolonged total length of stay in the ED compared with in-person evaluation. Findings indicate lower admission rates in patients assessed with TP in the ED. Limited data were reported for TP costs, its use for involuntary commitment evaluations, and its use for particular subgroups of patients (eg, those with a particular diagnosis). A single paper examined TP implementation process in the ED, which explored the barriers and facilitators for implementation among patients and staff in a rural setting.
Based on the extant studies, TP seems to be generally feasible and acceptable to key stakeholders. However, this review detected a gap in the literature regarding TP's effectiveness and implementation process in the ED setting. Specific attention should be paid to the examination of this service for specific groups of patients, as well as its use to enable assessments for possible involuntary commitment.
远程精神病学（TP）是一种实时视频会议，已在许多情况下得到应用。它在精神科急诊（ED）环境中有明显的优势，因为它可以加快对精神科患者的专家评估。然而，TP 在 ED 环境中的有效性以及在该环境中实施 TP 的过程方面的知识有限。
本范围综述旨在回顾 ED 环境中 TP 的行政和临床结果的现有证据，并确定在该环境中实施 TP 的障碍和促进因素。
根据 PRISMA-ScR（系统评价和荟萃分析扩展的首选报告项目）指南进行范围综述。检查了三个电子数据库：PubMed、Embase 和 Web of Science。从 2013 年 1 月到 2023 年 4 月，对这些数据库进行了搜索，以查找论文及其参考文献。从初步搜索中检索到了 2816 篇潜在相关论文。两名作者独立筛选和选择研究。
共纳入 11 篇文章。其中 10 篇论文报告了 ED 环境中 TP 使用的行政和临床结果，1 篇论文报告了其实施的障碍和促进因素。TP 在城市和农村地区以及有和没有现场精神科服务的环境中使用。证据表明，TP 缩短了精神科评估的等待时间，但在一些研究中，与面对面评估相比，它与 ED 总住院时间延长有关。研究结果表明，在 ED 接受 TP 评估的患者中，入院率较低。关于 TP 成本、用于非自愿承诺评估以及用于特定患者亚组（例如，具有特定诊断的患者）的数据有限。仅有一篇论文探讨了 ED 中 TP 的实施过程，该论文探讨了农村环境中患者和工作人员实施过程中的障碍和促进因素。
根据现有研究，TP 似乎总体上是可行和可接受的。然而，本综述发现 ED 环境中 TP 的有效性和实施过程方面的文献存在差距。应特别关注对该服务对特定患者群体的评估，以及其用于可能的非自愿承诺评估的使用。
