The COVID-19 pandemic placed limitations on face-to-face patient care, causing complexity for hospital psychiatric units. Undeterred, psychiatrists at the UW School of Medicine and Public Health quickly shifted to new ways of providing care.
Shortly after the novel coronavirus began appearing in Wisconsin, the Department of Psychiatry’s hospital psychiatry services group was subject to the same social distancing and personal protective equipment requirements as the rest of UW Health’s University Hospital, based on Centers for Disease Control and Prevention guidance.
This could greatly impact patient care, so it was imperative that a solution become available quickly, according to Marc Kalin, DO, clinical assistant professor at the UW School of Medicine and Public Health, and UW Health psychiatrist.
The remedy: telehealth.
“In response to the unprecedented challenges that COVID-19 presented to our hospital system, both in terms of minimizing use of personal protective equipment (PPE) and of maximizing social distancing, we deployed a comprehensive telehealth solution that allowed us to deliver outstanding patient care and maintain our educational mission,” he said.
UW Health’s transition to telehealth delivery was recently chronicled in The American Journal of Psychiatry. It can be found among the “Coronavirus Resources” featured on the journal’s homepage.
This technology allows the use of mobile devices and computers to visit with patients virtually through an electronic platform that safeguards privacy and is compliant with the Health Insurance Portability and Accountability Act (HIPAA).
To create its platform, the psychiatry department along with other hospital units turned to Tom Brazelton, MD, MPH, medical director for telehealth at UW Health, and his team.
In just a few days the telehealth team was able to quickly and effectively repurpose iPads that were already on each hospital unit for patients to use to interact with their providers who were using a computer or mobile device, Brazelton said, and for the entire health system ‒ both inpatient and outpatient ‒ in about three weeks.
“First, we had commitment by leadership to fully prepare for the COVID-19 pandemic by ensuring we could not just handle infected patients but continue to serve our patients who needed us regardless of the pandemic,” he said. “Second, we had an extremely talented team consisting of Information Services, Scheduling, Ambulatory and physician super-users who didn’t rest until we had a workable and safe solution.”
The hospital telehealth program rolled out on March 19 for the inpatient unit and for floor consultations. By March 23, the program was set up in the emergency department.
Since implementation of telehealth, all daily staffing and rounding encounters on inpatient psychiatry were completed by video and 96 percent of medical, surgical and emergency department consultations were completed remotely, which accounted for about 110 psychiatry visits. Some visits involving consultation for severe behavioral disturbances such as delirium or psychosis were still conducted in person, however.
The success of the telehealth program was also driven in large part because of the robust telehealth infrastructure already in place at UW Health, Kalin said.
The hospital system has a comprehensive electronic medical record that allows for remote management of hospitalized patients, plus the telehealth group had previously deployed a fully HIPAA compliant platform for stroke, a virtual intensive care unit, and specialty consultation to regional facilities.
“This prior experience established a technological base on which to rapidly expand,” Kalin said. “The institutional leadership within the Department of Psychiatry and the healthcare system was extremely supportive.”
Nobody knows how long the pandemic will last, but Kalin’s team has a tool that serves its patients well because of the visual-based interactive care they need.
“I do think it is a little bit easier for us to utilize telehealth as we in the psychiatry department are less hands-on,” he said. “This system allows us to see and talk with our patients in a way similar to our previous practice.”
When the pandemic has passed, and care at University Hospital returns to normal, it may not be the end of telehealth for use in psychiatric care or other medical areas, according to Brazelton.
“Telehealth is here to stay for every specialty and every patient,” he said. “While not for every condition, the standard of care can be met for many, and because it is essentially on the patients’ terms, if we are truly patient-centric, we will not go back to asking them to come to us for every visit, every time.”