Background Providing adequate psychiatry consultation capacity on a 24/7 basis is an intrinsic challenge throughout many multi-hospital healthcare systems. At present, implementation research has not adequately defined the effectiveness and feasibility of a centralized telepsychiatry consultation service within a multi-hospital healthcare system. Objective To demonstrate feasibility of a hub and spoke model for provision of inpatient consult telepsychiatry service from an academic medical center to two affiliated regional hospital sites, to reduce patient wait time, and to develop best practice guidelines for telepsychiatry consultations to the acutely medically ill. Methods The implementation, interprofessional workflow, process of triage, and provider satisfaction were described from the first 13 months of the service. Results This pilot study resulted in 557 completed telepsychiatry consults over the course of 13 months from 2018 to 2019. A range of psychiatric conditions commonly encountered by CL services were diagnosed and treated through the teleconferencing modality. The most common barriers to successful use of telepsychiatry were defined for the 20% of consult requests that were re-triaged to face-to-face evaluation. The average patient wait time from consult request to initial consultation was reduced from > 24 hours to 92 minutes. Conclusions This study demonstrated the feasibility of a centralized telepsychiatry hub to improve delivery of psychiatry consultation within a multi-hospital system with an overall reduction in patient wait time. This work may serve as a model for further design innovation across many healthcare settings and new patient sub-populations.

中文翻译：

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在多医院都市医疗保健系统中实施集中远程精神病学咨询服务：挑战与机遇

背景 在许多多医院医疗保健系统中，提供足够的 24/7 全天候精神科咨询能力是一项内在挑战。目前，实施研究尚未充分定义在多医院医疗保健系统内集中远程精神科咨询服务的有效性和可行性。目的证明中心辐条模式在从学术医疗中心向两个附属区域医院站点提供住院咨询远程精神病学服务的可行性，以减少患者等待时间，并为急症患者制定远程精神病学咨询的最佳实践指南。方法 从服务的前 13 个月开始描述实施、跨专业工作流程、分类过程和提供者满意度。结果 该试点研究在 2018 年至 2019 年的 13 个月内完成了 557 次远程精神病学咨询。通过电话会议方式诊断和治疗了 CL 服务经常遇到的一系列精神疾病。成功使用远程精神病学的最常见障碍是针对重新分类为面对面评估的 20% 的咨询请求。从咨询请求到初次咨询的平均患者等待时间从 > 24 小时减少到 92 分钟。结论 本研究证明了集中远程精神病学中心的可行性，以改善多医院系统内精神病学咨询的提供，并总体减少患者等待时间。