Connecting patients in crisis to care | TheUnion.com

Connecting patients in crisis to care

Mary Beth TeSelle
Special to The Union

Telemedicine: What you need to know

Telemedicine can be used for a variety of specialties and sub-specialties. At SNMH, it is used in the Emergency Department most often for neurology patients, specifically stroke patients who need quick evaluation and diagnosis in order to receive time-sensitive treatment. Telemedicine is also used at SNMH for pediatric critical care, when needed.

Every day, a steady stream of patients in need of care arrive to the Emergency Department at Dignity Health Sierra Nevada Memorial Hospital. Some need treatment for illness or injury. Some are suffering heart attacks or stroke. But for some, the crisis is different. For some, the care they urgently need is psychiatric.

“We see patients in need of acute psychiatric care every day,” explains Joseph Britton, MD, Emergency Department Medical Director at SNMH. “Most of the time we can address their concerns, treat, and recommend or coordinate follow-up, but there are other psychiatric presentations that will require a multi-disciplinary approach and sometimes in-patient care. These patients require a higher level of coordination with psychiatric specialists.”

Like most rural hospitals, SNMH is not staffed to provide 24/7 care for all specialties and sub-specialties, including psychiatric care.

That’s where telemedicine helps to fill the gap, enabling Dr. Britton and his team to meet the community need.

“Through telemedicine, we are able to connect a patient in psychiatric crisis with a psychiatrist who can see them, talk to them, and work with on-site staff to make a diagnosis and a treatment recommendation,” says Dr. Britton. “Telemedicine is truly vital to the care we provide.”

Telemedicine is a simple concept that uses high tech resources. It connects patients with physicians using the same technology as video conferencing.

“The telemedicine robot is brought to the patient’s bedside where it then connects with the on-call psychiatrist,” explains Dr. Britton. “The doctor may be at a different hospital or clinic or he may be in his home office. He can see the patient and talk to him or her, and also talk to the on-site medical staff.”

Using the robotic unit as well as on the on-site medical team’s input, the remote physician is able to make a diagnosis and formulate a treatment plan.

Dr. Britton says the telemedicine program has been used for patients needing urgent psychiatric care for about two years. He says the impact has been profound.

The first telepsych consults were funded by a grant secured by SNMH Foundation.

“Previously these patients would have been waiting until they could be seen locally or transferred to a distant psychiatric hospital. That’s just not a great solution when a patient is in the midst of a psychiatric crisis.”

Dr. Britton points out that the Crisis Stabilization Unit also plays a key role in the care that psychiatric patients receive at SNMH.

The CSU is a county service that works in partnership with the hospital, available 24/7 to patients in crisis.

If a patient is stable and not a danger to themselves or others, the CSU team will manage their symptoms and connect them with resources in the community.

If not, then the CSU team works with Dr. Britton’s team in the Emergency Department to connect the patient with a telemedicine psychiatrist.

In addition, Dr. Britton says care of patients in psychiatric crisis has improved tremendously due to the hospital’s recent Emergency Department renovation.

“Previously, patients in crisis were evaluated and managed in small spaces adjacent to the ED entrance,” Dr. Britton says. “Privacy was limited and there were no special accommodations for their unique needs. Now, as part of the renovation, we have rooms that are private, modern, spacious, and safe. We can control the lighting and the climate and modify the environment based on the patient’s needs. All of these things make a huge difference for patients in psychiatric crisis.”

Dr. Britton credits this collaborative and compassionate approach to patient care with having a real and positive impact on the care provided to patients needing emergency psychiatric care in Nevada County.

“Our emergency department team is so thankful to the county for their commitment to our partnership and to the Crisis Stabilization Unit – that relationship is vital to the care we provide,” he says. “And as a community, it’s important to recognize the commitment that Sierra Nevada Memorial Hospital and its benefactors have made to making the improvements necessary to provide the best care possible to all our patients, including, in this case, those in need of urgent psychiatric care.”


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