Emergency Physician Versus Telemedicine Psychiatrist Impression of Patient Need for Inpatient Psychiatric Care.

Abstract

Telemedicine psychiatry has become increasingly prevalent in emergency medicine settings. Given the limited prior research, we evaluated the interrater agreement between emergency physicians (EPs) and telemedicine psychiatrists regarding the assessment of safe disposition for mental health patients in the emergency department (ED). This prospective, observational study was conducted at an urban, community teaching hospital. A convenience sample of adult ED patients presenting with mental health-related complaints was included for analysis. Following their evaluations, EPs completed structured forms documenting history findings and assessments of appropriate disposition. Subsequently, each patient was evaluated by a telemedicine psychiatrist, and their assessments were recorded. Categorical data were analyzed using chi-square tests, and multivariate logistic regression was performed to control for confounding variables. Interrater agreement was assessed using Cohen's kappa (κ) statistic. A total of 118 subjects were enrolled; mean age was 39 ± 15 years, 48% were female, 43% Hispanic, and 47% non-Hispanic white. Among participants, 64% presented with suicidal ideation. Agreement between EPs and psychiatrists was moderate for prior suicide attempts (κ = 0.48) and substantial for prior psychiatric history (κ = 0.71), prior ED visits for psychiatric complaints (κ = 0.75), and prior inpatient psychiatric care (κ = 0.75). Agreement on current suicidal ideation was substantial (κ = 0.71), but agreement on disposition safety was fair (κ = 0.29). Multivariate logistic regression revealed no patient characteristics or historical features significantly associated with EPs recommending more conservative dispositions. Interrater agreement between EPs and telemedicine psychiatrists was fair regarding the safe disposition of ED patients with mental health complaints, with EPs tending toward more conservative assessments.