Baptist Health uses telemedicine to provide 24/7 vital care for suicidal patients
As the premier provider of inpatient behavioral health care in the Central Alabama region, Baptist Health depends on delivering high-quality, continuous care without interruption throughout the community.
THE PROBLEM
Staff have been working to resolve two separate but interconnected issues surrounding this important service line.
“The first issue we had to address was the ability to efficiently and effectively assess patients who are considered at risk for suicidality for possible inpatient admission by our team of trained mental health personnel,” said Julie Firman, DNP , RN, system chief nursing officer at Baptist Health.
“All patients who come to us are screened by a registered nurse who uses the Columbia Suicide Severity Rating Scale (C-SSRS) to quantify initial risk level; however, patients who screen at moderate or high risk require additional assessment by our qualified psychiatric intake team.
“At our Baptist Medical Center South campus, our tertiary care center and largest inpatient facility, we have the Crossbridge Behavioral Health psychiatric facility, which is staffed 24/7 with intake team services,” she continued. “Our dilemma was how to create a streamlined workflow so that they could most efficiently support our other acute care facilities – Baptist Medical Center East and Prattville Baptist Hospital – during times when they did not have intake team coverage.”
Physical commuting was not at all efficient and telephone assessments, although more feasible, did not allow the intake team to fully assess the patient’s affect, mood and general behavior to help determine the best and safest course of treatment, she added to. It’s very difficult to paint a complete picture of the disease just over the phone, she said.
“Second, we are very proud of our progress in opening and maintaining a geriatric psychiatric unit at Prattville Baptist Hospital, our community hospital that has served the area for more than 70 years,” she noted. “This new service line is part of our long-term strategy at Baptist Health, and we knew when we started that it would be difficult to recruit and retain psychiatric medical staff to support our efforts in this area.
“We have a fantastic medical group that provides coverage for this unit; however, there were certain scenarios and time frames where we had to look at creative alternatives to maintain appropriate coverage 24 hours a day,” she continued. “Our overarching goal for this unit was to develop a method to maintain continuity of care for this vulnerable patient population.”
PROPOSAL
The staff knew from the start that a telehealth system could provide value in solving these problems.
“Our organization already uses a virtual nursing platform and service, so we were fortunate to have some experience in this area, as well as existing audio/video infrastructure that we could use as a starting point before implementing these use cases in the field behavioral health came to the surface,” Firman explained. “We have installed approximately 480 beds with our virtual nursing platform – including every medical-surgical bed, every emergency department bed and four intensive care units – across our three acute care facilities.
“Our goal in expanding the use case to behavioral health was to leverage, to the extent possible, this existing hardware and software setup,” she continued. “Since this equipment is all hardwired and installed in each patient care room, we also understood that we needed some form of mobility to support the assessment of patients who were not physically in locations where we have the system available.”
Within the geriatric psychiatry department, the logistics were slightly more complicated. An extenuating circumstance within this department was that the staff could not use the existing virtual nursing platform in the room.
“We were originally unable to install the wired equipment because we had no way at the time to enforce anti-ligature requirements to meet standards of care when treating psychiatric patients, while still maintaining the functional quality of the audio and video to provide an actionable healthcare experience,” said Firman.
“In this case, we turned to a separate telehealth platform that was already in place within our organization to fill this gap,” she continued. “Our primary outpatient and ambulatory telehealth software is already set up for use via a mobile device and can be accessed via a laptop, tablet or smartphone using just a web browser.”
Staff stated that this system would provide the flexibility needed to support Prattville Baptist’s behavioral health department and be agile enough to assess patients at the bedside or in common areas, which would not have been an option with the virtual nursing platform .
MEETING THE CHALLENGE
The virtual nursing system, through which staff implemented remote assessment of patients at high risk of suicide, runs on supplier Banyan Medical Systems’ Solaborate platform. It integrates with the electronic health record, Oracle Cerner, via an ADT feed to display patient demographics, room numbers and census data directly in the application.
Access is strictly controlled and is only available through the secure network to maintain security and privacy. The approach in implementing the behavioral health intake team’s use of this platform was to largely mirror the workflows used by the virtual nurses; However, the most important distinction in this case was that this non-traditional method of communicating with the patient did not worsen the patient’s condition or mental status.
“We accomplished this by creating a standard script to properly route the patient to the virtual platform before engaging our remote psychiatric intake team,” said Joseph M. Cook, DNP, RN-BC, chief nursing informatics officer at Baptist Health. “Making sure the patient understands what is happening before it happens was very important to us; we did not want to create a scenario where our telehealth staff interacted with the patient before they were aware of the concept of a virtual interview and assessment.
“We were also aware that a member of staff was always physically present at the bedside to assist with assessment and reassure the patient if necessary,” he continued. “Our intake staff will then have access to two cameras installed in each patient care room: a panning camera to view and assess the patient and any bedside visitors, and a 20x zoom camera if it is necessary to conduct targeted assessments.”
The intake team member is also on camera, so the patient can interact with him or her as if the interview were taking place in person.
“We have taken a similar approach in our geriatric psychiatry department, albeit with a different platform,” Cook explains. “We use both the Amwell Now and Amwell Embedded applications, depending on provider preference, to conduct mobile provider rounds and assessments of our patients within this unit.
“Our Amwell Embedded platform is also integrated into our Cerner EHR and can be accessed directly from Cerner Powerchart within the context of the patient record,” he continued. “This allows providers to review records, document notes and assessments, and initiate the telehealth visit – all without leaving the patient’s chart.”
The geriatric psychiatry nurses are also closely involved in this process. They are responsible for ensuring that the device, usually an iPad, is connected to the platform, helping to initiate the virtual visit with the provider, and remaining with the patient to ensure privacy and confidentiality are maintained during the session.
Logistically, with the nurse’s assistance, once the caregiver launches the Amwell application from the card, the patient simply accepts the link via the iPad and the two-way audio/video begins. It’s a very simplistic and straightforward process, Cook noted.
RESULTS
To quantify the success of this initiative, Baptist Health focused on two primary outcomes.
“Our original goal, which we have had great success with to date, was to ensure that every patient screened as moderate or high risk for suicide receives a comprehensive behavioral health assessment by a qualified professional in a timely and efficient manner,” Firman reported. “Since fully implementing this telehealth model in September, we have had 24/7 behavioral health intake team coverage for every phase of care at all three of our acute care hospitals.
“From a patient safety perspective, this was a very important milestone for us to ensure we provide the highest level of care to one of our most vulnerable patient populations,” she continued. “Additionally, this new process has allowed us to reach a more efficient and decisive clinical consensus on the course of treatment for these patients, which has helped improve flow and bed placement decisions.”
For the geriatric psychiatric patients, the primary goal was to provide uninterrupted continuity of care by maintaining daily medical staff coverage for all admitted patients.
“We recently implemented this telehealth system in November, but even in this short time, we have a system that allows us to evaluate and complete every patient every day by the same medical-psychiatric group, without the need for temporary services or locum providers,” she said.
“Our patients feel more comfortable when they can build relationships with their care team, and Amwell’s telehealth system has allowed us to maintain this continuity and familiarity within the department and patient population,” she added.
ADVICE FOR OTHERS
In Firman’s experience, the most important aspect of implementing new technology within the clinical care environment is ensuring that the patient is properly oriented to the technology itself, as well as the experience he or she will gain.
“We learned this a few years ago during our implementation of virtual nursing, and it applies to us with these behavioral health initiatives as well,” she said. “Our experience is that when we can increase understanding of the technology through education, we can also increase acceptance and adoption of these new models for both staff and patients.”
Baptist Health is also exploring options to launch an external marketing and education plan to help the community better understand and appreciate the healthcare system’s standards of care and technological innovations.
“Also, it has been our experience that the stationary, wired equipment provides a better user experience from a connectivity perspective, but we have learned that this is not absolutely necessary in areas that do not support it,” she said. “Installing A/V equipment in individual patient care rooms is a heavy capital investment, and I would encourage healthcare systems not to let this deter you if mobile devices are your only option.
“We have had very positive experiences to date using the telehealth platform on a tablet attached to a mobile cart, with a very low capital investment and the ability to expand quite quickly if necessary,” she concluded.
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