Telepsychiatry "coverage" to a rural inpatient psychiatric unit.

OBJECTIVE: Rural psychiatrists responsible for inpatient psychiatry units in general hospitals often have trouble getting coverage for training, vacations, and periods of illness. This article describes telepsychiatry "coverage" to a rural general hospital psychiatric unit for 1 week.
MATERIALS AND METHODS: All adult patients meeting criteria for inpatient mental health treatment in the emergency room were offered admission to the general hospital after obtaining informed consent regarding the use of inpatient telepsychiatry. The number of patients on the inpatient psychiatric unit ranged from three to nine, with an average daily census of seven. All psychiatric care was provided via video teleconferencing (VTC) at a bandwidth of 512 kilobits per second using Internet Protocol.
RESULTS: Patients with psychosis reported more difficulty hearing the doctor than patients without psychosis and incorporated VTC into delusions in a congruent manner. Patients rated development of rapport and effectiveness of treatment higher than staff ratings. Two staff thought telepsychiatry was either not effective for acutely psychotic patients or more effective with higher functioning patients.
CONCLUSIONS: Short-term coverage of rural inpatient psychiatric units for purposes of vacation, training, and illness is possible using telepsychiatry. Psychiatrist's efficiency and consistency are enhanced with instantaneous connections possible from hospital, office, or home. Significant increases in staff workload will occur without remote access to electronic medical records, electronic physician ordering, and an adequate physical layout of the inpatient psychiatric unit. Adequate educational preparation of unit staff regarding telepsychiatry and a staff process group during implementation is recommended.