IMPLEMENTATION OF TELEBEHAVIORAL HEALTH
Children’ s Colorado operates a system of care, with locations across the Denver metro area and in southern Colorado. Prior to 2015, if a child presented with a psychiatric illness in one of the outlying Children’ s Colorado emergency department or urgent care sites, the common practice was to send the patient by ambulance to the psychiatric emergency services on the Anschutz Medical Campus in the Denver metro area for an inperson evaluation.
It was an expensive model that didn’ t align with a target objective: optimal care for patients close to their home.
In 2015, the telehealth team deployed a synchronous telepsychiatry consultation model, linking patients at care sites in real time with the centralized psychiatric emergency service team at Anschutz instead of transporting them for in-person consultation. Emergency medicine physician Alison Brent, MD, Medical Director Network of Care, was a principal investigator for a yearlong pilot study of that model, which showed 50 % fewer ambulance transfers and more than 50 % reduction in cost. That’ s in addition to a substantial decrease in wait times for patients as well as outstanding patient, parent and practitioner satisfaction( 1).
“ It was a real test case success story for telemedicine that positively impacted the entire health care system and demonstrated how well telemedicine was accepted by patients, families and team members,” she says.“ It was a total win-win.”
Based on those promising results, the telehealth team began to prewire inpatient and ED rooms at newer sites of care for telemedicine visits. Those rooms come complete with a pantilt-zoom camera that can see even the smallest of freckles on a child’ s skin, as well as peripheral devices including a stethoscope, otoscope and magnifying glass, which can be accessed remotely.
SWIFT ADJUSTMENTS FOR THE COVID-19 PANDEMIC
All of that work and much more came into play when Children’ s Colorado providers had to rapidly adjust their care models due to the COVID-19 pandemic. In the first six business days of April 2020, they completed more than 5,000 outpatient telehealth visits. That’ s roughly equal to the number of telehealth visits they completed in all of 2019.
“ We were basically able to accomplish in five days what was ultimately our five-year plan for instituting the same kind of cost-savings benefits we saw with the telebehavioral health model to our inpatient, outpatient, ambulatory and ED models,” says Dr. Brent.
Pediatric cardiologist Adel Younoszai, MD, Assistant Medical Director of Ambulatory at Children’ s Colorado, chimes in:
“ We could expand those models so quickly because we had a great foundation,” he says.“ Software, licenses, training, consents, billing and IT support— all of it was already in place. So it was literally a matter of increasing the number of licenses, and hardware to accept those licenses, and we were off and running.”
AN IDEA FOR ED AND INPATIENT CARE
As Dr. Brent was evaluating each patient under investigation for the COVID-19 virus that came through the Anschutz ED, she says she thought back on the team’ s installation of in-room technology at newer campuses. Implementing similar technology in the inpatient and ED rooms at Anschutz would mean that providers could harness the audiovisual power of telemedicine to connect with their patients safely and remotely. It would also alleviate strain on a valuable resource: PPE. She expressed that sentiment to hospital leadership and the telemedicine team.
With hospital support, there was a telemedicine device in 566 inpatient rooms throughout the system within a week, and plans were in place to outfit specific rooms in each of the system EDs.
It took an incredible amount of rapid coordination and work for dozens of people across multiple teams, including clinical, IT and medical information officers, but it ultimately created a safer environment for everyone.
THE NEW STANDARD OF CARE
Pediatric gastroenterologist Michael Narkewicz, MD, Associate Dean for Clinical Affairs and a key leader on the telehealth team, sees the coronavirus pandemic as a paradigm shift.
“ Telehealth really is great care, and we’ ve known that for a long time,” he says.“ But COVID-19 has really pushed more providers toward that model, and I think it’ s ultimately going to change the way we provide care and the way people expect care moving forward.”
His long-term vision is a blurring of boundaries. Rather than inperson or telehealth, it’ s simply the right care for the right patient at the right place or with the right access. •
1. Thomas, J. F., Novins, D. K., Hosokawa, P. W., Olson, C. A., Hunter, D., Brent, A. S., Frunzi, G., & Libby, A. M.( 2018). The Use of Telepsychiatry to Provide Cost- Efficient Care During Pediatric Mental Health Emergencies. Psychiatr Serv. 2018 Feb 1:69( 2): 161-168.
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