Use of Telepsychiatry in Pediatric Emergency Room to Decrease Length of Stay for Psychiatric Patients, Improve Resident On-Call Burden, and Reduce Factors Related to Physician Burnout
Background: Our study aims to demonstrate through implementation of telepsychiatry for child psychiatry patients evaluated in the pediatric emergency room (PedsER); we can reduce length of stay (LOS) and reduce factors contributing to physician burnout through reduction of on-call travel burden.Introduction: Telepsychiatry has increased access to health care using real-time interactive videoconferencing, allowing clinicians and patients in separate locations to have a meaningful clinical encounter. Use has increased over the past several years given cost reduction and need for psychiatric specialty services in under-resourced systems.Materials and Methods: We evaluated data regarding child psychiatry fellow use of telepsychiatry through a prospective real-time questionnaire filled out by the on-call clinician from July 1, 2017 to December 23, 2017 (study period). LOS was measured from the patient's registration time through time of discharge.Results: Telepsychiatry significantly reduced the total monthly LOS for nonhospitalized patients in the PedsER during the study period compared to all prior months (285-193â€‰h; pâ€‰=â€‰0.032) and compared to a similar prior seasonal time frame (329-193â€‰h; pâ€‰=â€‰0.017). Telepsychiatry use reduced travel for face-to-face evaluations by 75% and saved 2.22â€‰h per call day.Discussion: Unique in this study is enhancing on-site psychiatric consultation in the emergency room, rather than solving a systems issue of referring out for psychiatric consultation. Moreover, this study uniquely demonstrated a noted improvement in on-call physician travel burden by reducing travel time with telepsychiatry. Physician burnout is notably high during residency training. Factors such as telepsychiatry can improve work efficiency and lend time to activities outside of work, mitigating the onset of this challenging issue.Conclusions: Telepsychiatry was shown to be effective in reducing dwell time and improving on-call burden. This study also showed promise in our system for improving access to other forms of specialized care consultation in PedsER settings.
Negative and distorted attributions towards child, self, and primary attachment figure among posttraumatically stressed mothers: what changes with Clinician Assisted Videofeedback Exposure Sessions (CAVES)
This study found that within a non-referred community pediatrics clinic sample, the severity of mothers' trauma-related psychopathology, in particular, their interpersonal violence-related (IPV) posttraumatic stress, dissociative, and depressive symptoms predicted the degree of negativity of mothers' attributions towards their preschool age children, themselves, and their own primary attachment figure. Results also showed that mothers with IPV-related posttraumatic stress disorder (PTSD) as compared to non-PTSD controls showed a significantly greater degree of negativity of their attributions toward their child, themselves and their primary attachment figure during childhood. The study finally found a significant reduction in the degree of negativity of mothers' attributions only towards their child following a three-session evaluation-protocol that included a form of experimental intervention entitled the "Clinician Assisted Videofeedback Exposure Session(s)" (CAVES), for mothers with IPV-PTSD as compared to control-subjects.