Telepsychiatry to Enable Expedited Disposition of Psychiatric Emergencies

The goal of this observational study is to examine the effect of using a video link for evaluation of patients in the psychiatric emergency room. Under current Israeli law, the attending physician must come in to physically examine the patient before they can be admitted involuntarily. Patients often de-compensate and even may become violent while waiting for the attending to arrive. Previous studies have shown that evaluation of such patients via video-link has an extremely high concordance with in person evaluation. This study will compare patients who are evaluated via video-link with historical controls evaluated under usual conditions. This is an observational study, which is taking advantage of a change in practice to collect data on two different ways of delivering care, via chart reviews. If successful, this study will show that the video-link is feasible and acceptable to patients and staff. The following hypotheses will be tested:

1. The intervention will result in shorter ED time compared to historical controls.
2. The intervention will result in fewer violent incidents compared to historical controls.
3. The intervention will result in shorter overall hospital length of stay compared to historical controls.

Study Overview

• Status: Recruiting
• Conditions: Psychiatric Emergency
• Intervention / Treatment: Other: Telepsychiatry

• Study Type: Observational
• Enrollment (Estimated): 800

Contacts and Locations

• Study Contact: Name: Adam J Rose, MD; Phone Number: +972555001040; Email: adam.rose@mail.huji.ac.il
• Study Contact Backup: Name: Ligat Shalev, PhD; Phone Number: +972507554025; Email: ligat.shalev@gmail.com

Study Locations

• Israel
  • Jerusalem, Israel
    • Recruiting
    • Jerusalem Mental Health Center
    • Contact: Suhaib Kirresh, MD; Phone Number: +972-54-317-6343; Email: suhaib_kirresh@hotmail.com
  • Sha'ar Menashe, Israel
    • Recruiting
    • Shaar Menashe Mental Health Center
    • Contact: Daniel Bathich, MD; Phone Number: +972542587218; Email: D.b.91@hotmail.com
  • Tel Aviv, Israel
    • Recruiting
    • Tel Aviv Sourasky Medical Center
    • Contact: Renana Eitan, MD; Phone Number: +972-3-697-4707; Email: renanae@tlvmc.gov.il
  • Ẕur Moshe, Israel
    • Recruiting
    • Lev Hasharon Mental Health Center
    • Contact: Adi Tamary Guterman, MD; Phone Number: +972-52-520-2762; Email: tamary.adi@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

All patients who are evaluated for involuntary psychiatric admission via the ED, who meet the above criteria.

Description

Inclusion Criteria:

• Must be evaluated in the psychiatric ED for potential involuntary admission

Exclusion Criteria:

• Not justice-involved (i.e., brought in by police after committing a crime)

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Pre-Innovation (Usual Care); Patients evaluated in the psychiatric emergency department for possible involuntary admission during the year prior to the innovation in care. During this period, the attending psychiatrist was required to physically come to the hospital to examine the patient.
Innovation (Tele-Psychiatry); Patients evaluated in the psychiatric emergency department for possible involuntary admission during the innovation period. Instead of physically coming to the hospital, the attending physician will evaluate the patient via video-link, which will be facilitated by the on-site psychiatric resident.	Other: Telepsychiatry; Instead of coming to the hospital physically, the attending psychiatrist will evaluate the patient via a video-link.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
ED Time	Amount of time, in hours and minutes, that the patient spends in the ED prior to disposition	Patients arrive in the ED at a specific time and leave the ED at a specific time. We will compute the amount of time spent in the ED by each patient, up to two weeks.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Violent Incidents	Adjudicated violent incidents that occur, whether in the ED or on the psychiatry ward. Includes hitting, kicking, throwing, and property destruction	Patients arrive in the ED at a specific time. Those who are admitted are eventually discharged. Violent incidents can occur during the entire time spent in the hospital, whether in the ED or on the ward, up to 90 days total.
Hospital Length of Stay	Length of stay, in days, starting with time of arrival to ED	For patients admitted to the hospital through the ED, the beginning time is their arrival to ED, the end is the time of hospital discharge, up to 90 days later.

Collaborators and Investigators

• Sponsor: Hebrew University of Jerusalem

Study record dates

Study Major Dates

• Study Start (Actual): July 1, 2023
• Primary Completion (Estimated): September 30, 2024
• Study Completion (Estimated): September 30, 2025

Study Registration Dates

• First Submitted: March 2, 2023
• First Submitted That Met QC Criteria: March 14, 2023
• First Posted (Actual): March 16, 2023

Study Record Updates

• Last Update Posted (Actual): September 22, 2023
• Last Update Submitted That Met QC Criteria: September 21, 2023
• Last Verified: September 1, 2023

More Information

Terms related to this study

• Keywords: implementation science; telepsychiatry
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: HebrewUJ123

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: It is not possible to share IPD because of data security concerns and the stipulations of the research ethics committees that are approving the study

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No