Development and implementation of a new electroconvulsive therapy service line at a major medical center

Electroconvulsive therapy (ECT) is a highly effective and standardized psychiatric treatment, yet the operational development of a new ECT service line within large academic medical centers remains complex and underrepresented in the literature. The expansion of inpatient psychiatric services at the University of Colorado Anschutz Medical Campus in 2023 created an opportunity to develop a new ECT service line. This article describes the multidisciplinary planning, implementation, early challenges, and optimization of this service, with the goal of providing a practical framework for other institutions. A multidisciplinary team of psychiatrists, anesthesiologists, nurses, pharmacists, and information technology staff collaboratively designed and implemented the ECT service. Planning included site observations at peer institutions, development of staffing models, medication management strategies, emergency protocols, and electronic medical record optimization. Standardized workflows for pre-procedure assessment, intra-procedure management, and recovery were established and refined. This descriptive study reports operational processes and early outcomes; no statistical analyses were performed. The ECT service was successfully launched and sustained over two years, supported by a core group of anesthesiologists, advanced practice providers, and nursing staff. Key challenges included inconsistent patient volume affecting staffing efficiency, ethical and legal complexities surrounding informed consent, and the management of patients with significant comorbidities, including pregnancy and cardiovascular disease. Targeted adaptations, such as revised staffing strategies, development of serial anesthesia consent processes, and enhanced interdisciplinary communication, improved operational efficiency and patient safety. Ongoing education, simulation training, and protocol development further supported service growth and quality improvement. The establishment of a new ECT service line within a large academic medical center is feasible but requires extensive multidisciplinary collaboration, flexible workflow design, and continuous quality improvement. This article provides operational guidance for institutions seeking to develop similar services, with implications for improving access to safe, effective ECT and advancing patient-centered psychiatric care.