inpatient psych replaced by telehealth?

[nexus73]

Has anyone seen an inpatient psych unit staff replaced with telepsych?

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[Jules A]

I have not although I worked a unit where 2 elderly psychiatrists and the hospital CL psychiatrist did it during the first few months of pandemic. The rest of us had to be on-site.

 

[Sushirolls]

I suppose its possible.
A group could come in, low ball a contract and kick out the existing staff.
But in some ways that would be poor planning on part of a hospital. Just as quickly they came, in they can leave. Much harder to get people who are living local, and likely more vested in quality being its their community.

A bunch of residents, if they are socially friends, could come together to form a group post residency and do just that. People scatter to the wind geographically, but essentially form a medical group for hire.

 

[PikminOC]

Yes Rogers and Rosecrance, two large hospital systems, do tele for ip psych

 

[Merovinge]

Yes Rogers and Rosecrance, two large hospital systems, do tele for ip psych

Rosecrans does IP psych at all? Or do you mean for residential?

 

[HomerWells]

Haven't seen inpatient psychiatrists being "replaced" by telepsych as often as I have seen hospitals in less desirable locations forced to use telepsych to staff their hospitals. Given the choice they would prefer in person though.

 

[forchinet121]

Tele inpatient is worse for the patient than in person and I would be wary of any hospital that thinks that’s acceptable

 

[comp1]

Psych units aren't run like EDs generally... They don't have a physician service they contract with that they could simply replace with a telehealth physician service. Instead, they generally either use individual contractors on 1099's (UMC) or they directly employ providers like at Kaiser or a VA. So, your phrasing is off. They aren't going to just replace all staff in a single swipe. Some very rural facilities indeed have had to move entirely to telepsych even before COVID. It's not ideal, but it can work. It's a much higher burden on nursing.

 

[nexus73]

Psych units aren't run like EDs generally... They don't have a physician service they contract with that they could simply replace with a telehealth physician service. Instead, they generally either use individual contractors on 1099's (UMC) or they directly employ providers like at Kaiser or a VA. So, your phrasing is off. They aren't going to just replace all staff in a single swipe. Some very rural facilities indeed have had to move entirely to telepsych even before COVID. It's not ideal, but it can work. It's a much higher burden on nursing.

Thanks for that perspective, I'm asking about a group of employed psychiatrists getting pink slips to bring in telehealth.

 

[whopper]

I only like doing telemedicine if the patient is doing relatively well. It's terrible for ER psych and inpatient. There's a type of thing where you figure stuff out cause the patient's been observed for hours that can be done on inpatient. Of course usually not that you're seeing the patient for hours but they're in the background of where you can see or hear them while you're doing other stuff. Also if the staff members of that unit are terrible it's easier to figure out if you're at the hospital.

For ER same thing. Also some patients can hold it together real well during telemedicine for whatever reason but in person can't hold it together. Why this is I don't know. Patient for example is agitated, paranoid, irritable but when placed in front of a camera they're fine for a few minutes.

 

[allantois]

Nurses absolutely hate it; usually they have to be present for those tele appointments and there’s already not enough of them to staff the units as is

 

[TheRightMedication]

I rely on my gestalt sense of a person quite a bit for inpatient work, and every now and then you have to do a physical exam for NMS, catatonia, drug withdrawal, anticholinergic signs, or those odd cases that demand some attention to the neuro exam. Just for starters.

I also rely on that sense for interactions with nursing, social work, ect. And the actual, moment to moment functioning of a unit is built on those relationships as well, in my opinion.

Hard to imagine inpatient psychiatry by correspondence.

 

[whopper]

Despite what I mentioned above I can see situations where a place is forced to do telemedicine even if it's not the right thing. I've seen several places resort to using NPs when an MD really should be doing the job. I heard this from a reliable source who is a Ph.D. psychologist-the state is so desperate to get a psychiatrist at their state hospital and don't have enough they're having psychologists pseudo-prescribe. That is the psychologist tells the PCP at the facility what to prescribe despite that this is highly controversial and not appropriate. Despite this the state (not surprisingly) isn't doing what you'd expect it should do to attract more psychiatrists like, ahem, offer more pay. Also this is not a state where psychologists obtained the legal authority to prescribe meds.

So with the above going on, with so many patients seeing NPs without adequate psychiatry training does that make telemedicine out of the question? Doesn't seem so to me despite that this isn't right.

 

[drillers]

Despite what I mentioned above I can see situations where a place is forced to do telemedicine even if it's not the right thing. I've seen several places resort to using NPs when an MD really should be doing the job. I heard this from a reliable source who is a Ph.D. psychologist-the state is so desperate to get a psychiatrist at their state hospital and don't have enough they're having psychologists pseudo-prescribe. That is the psychologist tells the PCP at the facility what to prescribe despite that this is highly controversial and not appropriate. Despite this the state (not surprisingly) isn't doing what you'd expect it should do to attract more psychiatrists like, ahem, offer more pay. Also this is not a state where psychologists obtained the legal authority to prescribe meds.

So with the above going on, with so many patients seeing NPs without adequate psychiatry training does that make telemedicine out of the question? Doesn't seem so to me despite that this isn't right.

Sadly that sounds like so many state hospitals right now...

 

[reca]

What state hospital is offering telepsych? I’d be super interested but haven’t found any.