The immediate and long-term mental health effects of the COVID-19 crisis has significant implications for hospitals across the country who are bracing for a surge in the number of patients presenting with mental health issues in the wake of prolonged social isolation, rising unemployment, economic instability and pervasive fear, uncertainty and anxiety. Given the expected groundswell of mental health needs, hospitals are turning to telepsychiatry to provide as-needed psychiatric assessments and care.
Telepsychiatry is being used in hospital emergency departments (EDs) to help triage psychiatric patients and refer them to the appropriate level of care more quickly and efficiently. Timely access to psychiatric assessment via telepsychiatry has been shown to shorten wait times, reduce overcrowding in the ED and improve patient satisfaction.
Telepsychiatry is also used to support a hospital inpatient medical unit. Prior to the COVID-19 crisis, there was a nationwide shortage of mental health professionals, particularly psychiatrists. In the wake of the pandemic, these scarce resources are even more strained and overextended, leading to significant delays and long wait times for their services. Telepsychiatry can help alleviate this by connecting the hospital team with remote psychiatrists who can assist with clearance evaluations so medical-surgical patients can be discharged more quickly, reducing the strain on the system and minimizing patients’ risk of exposure to COVID-19 from an extended hospital stay.
To address the escalating need for both medical and mental health care in the wake of the COVID-19 crisis, many hospitals across the country are seeking to quickly expand their network of healthcare providers by adding remote clinicians to their ranks. While additional practitioners are needed to handle the increased volume, all new clinicians – both onsite and remote – must be properly credentialed and privileged in order to practice within a hospital.
Credentialing is a lengthy, complex process that is unique to every clinician and organization. The time it takes to collect, review and approve the necessary documentation for credentialing can extend for months and can significantly impact the time it takes to establish a telepsychiatry program.
Privileging involves the granting of certain permissions by hospitals to an individual clinician to perform specific aspects of patient care. Privileging decisions are made based on the portfolio of information and materials collected and reviewed during the credentialing process. Examples of privileges include admitting, placing orders, prescribing and performing procedures. If a remote clinician is not privileged with an organization, they may not be able to directly assess a patient.
Committees at each hospital generally approve privileges. The regularity or frequency with which these committees meet varies widely, which can delay the implementation of telepsychiatry services and further prolong wait times for behavioral health patients in need.
Given that the standard credentialing and privileging process typically takes a few weeks to a few months to complete, alternative solutions are needed during the COVID-19 crisis in order to safely and quickly meet patient care needs.
Temporary and disaster privileges are two options that could help hospitals meet the significant and growing need for care during the COVID-19 crisis and in its aftermath. Granting temporary and disaster privileges would help expedite the provision of patient care since it would allow telepsychiatry providers to start delivering behavioral health services more quickly while they await review and approval by the medical staff committee and governing body of the hospital.
According to the Joint Commission, temporary privileges can be granted in situations where the patient care volume exceeds the level that can be handled by currently privileged practitioners. Disaster privileges are temporary privileges a hospital may grant for various reasons according to their bylaws, such as during a declared local or national emergency if the hospital is unable to meet immediate patient needs and requires outside assistance to sustain patient care.
Disaster privileges are also governed by hospital bylaws or policies, and only extend for the duration of the emergency whereas temporary privileges may allow a physician to practice for up to 120 days and can be extended for intervals of 30-60 days until a full credentials review can be performed and permanent privileges are granted. Since the need for mental health care will persist long after the immediate threat of the coronavirus subsides, hospitals should push for temporary rather than disaster privileging for telepsychiatry providers.
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