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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