Pragmatic Evaluation of an Urban-Based Emergency Telepsychiatry Program in Winnipeg, Canada: Évaluation pragmatique d’un programme urbain de télépsychiatrie d’urgence à Winnipeg, au Canada

ObjectiveEmergency telepsychiatry programs have demonstrated value in urban settings but remain under-studied in terms of their impact on access and flow. This pragmatic study assessed patients seen by a novel emergency telepsychiatry service over 4 years in Winnipeg, Canada, during a time of rapid system change. Outcomes were compared to a cohort of hospitalized individuals who received an in-person emergency psychiatric assessment during the same time period.MethodTelepsychiatry assessments between January 1, 2018 and December 31, 2021 were logged and linked with administrative data to examine variables pre-consult, during the episode of care, and post-consult. For individuals admitted to hospital following the telepsychiatry assessment, we generated a comparison group of individuals admitted following in-person consult at the eligible sites. Emergency Department length of stay (ED LOS), hospital admission diagnosis and days in hospital were compared between groups.ResultsA total of 558 telepsychiatry consults were logged during the study period of which 520 (93.1%) were successfully linked to administrative data. The volume of telepsychiatry consults decreased over time in parallel with changes to in-person staffing and referring facility designation. Rate of admission following the telepsychiatry assessment was 50% or lower across all years. For comparison, 222 telepsychiatry and 756 in-person visits resulting in psychiatric hospital admission were identified. Telepsychiatry-triggered hospitalizations were more likely to be for individuals presenting during daytime (0801-1700 h) and with mood/suicidal chief complaints at triage (<i>P</i> < 0.001). No differences in overall ED LOS, admission diagnosis, or days in hospital were observed.ConclusionTelepsychiatry services in urban ED settings have the potential to offer access to timely consults in the absence of in-person care. This model can optimize resources and offer flexibility in the face of rapidly evolving and unanticipated health system changes.