Telepsychiatry Expansion of Inpatient Psychiatry Services During the COVID-19 Pandemic

During the early COVID-19 pandemic, most psychiatric facilities did not admit SARS-CoV-2-positive youth, resulting in prolonged emergency department (ED) boarding and delayed psychiatric care. In response, our hospital enacted a small, single-site, innovative pilot enabling psychiatric admission of SARS-CoV-2-positive patients with lower behavioral acuity to an inpatient medical unit for comprehensive telepsychiatry programming. Patients transferred to the Telepsychiatry Model from our EDs or hospital medicine service after medical clearance. Psychiatrists from our adjacent traditional inpatient psychiatry unit (IPU) provided day-to-day care in partnership with medical nurses, behavioral health specialists, and consulting hospitalists on the general medical unit, and our traditional IPU's standard treatment protocol, milieu-based group therapy, was delivered via telehealth. Over its first 3 years, 64 patients received care under the Telepsychiatry Model. Behavioral escalations requiring intervention were rare, with 2 staff injuries reported. Most patients discharged home (92%; median length of stay, 7 days). No patients died by suicide within 6 months of discharge, and 12 (19%) received care in a state ED or psychiatric hospital within 30 days of discharge. This pilot successfully operationalized comprehensive telepsychiatry programming from an inpatient medical unit and has potential applications to future infectious outbreaks and delivery of psychiatric services to patients with high medical complexity, during inpatient psychiatry capacity crises, and in geographic locations with limited access to inpatient psychiatric care. To adopt a similar model, other institutions should invest in local infrastructure, partner with local regulatory leaders, and foster strong, collaborative relationships with remote psychiatric partners.