Abstract
High quality health services for psychiatric emergencies are difficult to maintain 24 h a day in sparsely populated areas, where the availability of specialists are limited. To overcome this challenge, the University Hospital of North Norway implemented an on-call system in psychiatric emergencies, by which psychiatrists are accessible 24/7 for telephone and videoconferencing consultations with patients and nurses at three regional psychiatric centers. The purpose of this study was to explore the usefulness of videoconferencing consultations in psychiatric emergencies. The on-call psychiatrists and nurses at the regional psychiatric centers who participated in at least one videoconferencing consultation were recruited for semi-structured interviews: 5 psychiatrists and 19 nurses for a total of 24 participants. The interviews were performed from July of 2012 to June of 2013. The interviews were transcribed and analyzed using a stepwise-deductive-inductive approach supported by the HyperRESEARCH analysis software. After the introduction of the videoconferencing system, telephone consultations were still used for straightforward situations when further treatment or admission decisions were obvious. Videoconferencing consultations, during which patients were present, were useful for challenging situations when there was 1) uncertainty regarding the degree of illness or the level of treatment, 2) a need to clarify the severity of the patient condition, 3) a need to build an alliance with the patient, and 4) disagreement either between health personnel or between the patient and health personnel. Videoconferencing is useful for challenging and complex psychiatric emergencies and is a suitable tool for building high quality, decentralized psychiatric services.
Highlights
Psychiatric emergencies require 24/7 health services for all patients, including those in remote or sparsely populated areas
We identified four types of situations in which the health personnel described VC as a useful and important tool in psychiatric emergencies: 1) when there was uncertainty regarding the degree of illness or the level of treatment, 2) when there was a need to clarify the severity of the patient condition, 3) when there was a need to build an alliance with the patient, and 4) when there was disagreement either between health
Telephone calls were preferred when nurses and psychiatrists felt confident in their assessment, while VC was used to bring the psychiatrist into the consultation room at the regional psychiatric centers (RPCs) and thereby reduce uncertainty
Summary
Psychiatric emergencies require 24/7 health services for all patients, including those in remote or sparsely populated areas. Videoconferencing (VC) may be a tool to replace physical co-location of patient and provider and has been used for decades for advanced psychiatric consultations in remote areas [3, 5,6,7]. Patients are satisfied with such services, due to increased access to therapy, quality of the consultation, saved time and reduced travel needs [2, 3, 9]. From the perspective of frontline mental health workers, access to psychiatric expertise through VC were reported to enhance the capacity of mental health services in remote and rural areas, by increased knowledge, competence and feeling of confidence in assisting their patients [5]. Experience with emergency telepsychiatry is limited, it is found to be safe, has improved patient assessment and care in acute situations, and reduced unnecessary admissions in emergency psychiatric wards [10]
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