Additional Core Service: Behavioral Health Concierge

Telepsych Patient Stories

Telepsych addresses shortage of psychiatrists

Telepsychiatry can deliver psychiatric care to patients in rural areas where access to psychiatric care is scarce. With access to psychiatric consultation, patients are more likely to get better and more cost-effective treatment; and can have shorter lengths of stay when hospitalized.

A 70 year old woman from rural WA presented into the Emergency Room with paranoia and agitation. The patient had no prior psychiatric history, but had a family history of bipolar disorder. Upon further investigation and interviews with the patient’s family, the patient had started an anti-smoking medication 2 months prior to admission resulting in significant insomnia to a point where she had not slept in 4 days. Our telepsychiatrist diagnosed the patient with mania, most likely induced by her anti-smoking medication. Within hours of her admission into the ER, her anti-smoking medication was stopped and she was put on antipsychotic medications. Telepsychiatry proved particularly helpful in getting background information on the patient, making a timely diagnosis, and implementing a targeted treatment.

Telepsych helps with differential diagnosis and reduces length of stay

A 60 year old woman was admitted into a Providence hospital because of altered mental status, which can be caused by underlying psychiatric condition or by injuries that cause damage to the brain. Telepsychiatry was consulted to help manage significant anxiety symptoms and to help rule out psychiatric issues contributing to her altered mental status. During the evaluation, the telepsychiatrist found the patient had a seizure like experience a few days prior to her hospital admission, which coincided with her running out of her benzodiazepine medication. Upon further investigation, the patient disclosed that she had been living alone and had been abusing benzodiazepines for the last 10 years. Our telepsychiatrist diagnosed benzodiazepine withdrawal and immediately put the patient back on her on benzodiazepines to stop the seizures. The patient was prepared for transfer to detox facility and referred to an outpatient MH provider, reducing her stay in the hospital.

Telestroke Patient Stories

The reach of telestroke

One of the biggest benefits of telestroke is its ability to have access to specialized stroke care regardless of geographical location within minutes.

A 65 year old man from Spokane, WA was traveling through Alaska on vacation. While in Valdez, Alaska (5+ hour drive to nearest large town Anchorage when roads allow driving) he experienced a sudden onset of left sided weakness and significant visual and sensory neglect. He presented at the emergency department at Providence Valdez Medical Center approximately 45 minutes after symptom onset. A telestroke provider (located in Portland, OR) did a video exam of the patient and recommended Alteplase (clot busting drug) 75 minutes after the patient arrived. The patient was then flown to the Providence Alaska Medical Center in Anchorage for more advanced imaging. Imaging done in Anchorage did not reveal a large vessel occlusion, and showed restored blood flow after the use of Alteplase. Because of the availability of telestroke in Valdez and the care coordination with Providence Alaska Medical Center in Anchorage, the patient was discharged two days later and his discharge exam was nearly normal with a mile residual neglect on his left side. The patient flew back home to Spokane and was referred to a local Providence vascular neurologist for follow-up. This physician also participates in the Providence telestroke service. The patient was very thankful for the help and the network of providers, and has vowed to return to Alaska to finish the trip.

Telestroke in a coordinated care system

With strokes, time is brain, meaning that fast treatment is crucial for the restoration of blood flow to brain tissue. A coordinated system of care that utilizes telestroke services is able to quickly access stroke expertise to aid in the accurate diagnosis as well as identify acute treatment options. The most common rescue therapy that a stroke team would use is an FDA approved medicine called Alteplase, however there are additional interventions comprehensive stroke services can also offer.

On a Thursday morning in Richland, WA, a 77 year old man was driving and talking to his wife when she noticed he wasn’t making any sense. She thought he was having a stroke so she assisted him with safely pulling the car off the road and called 911. The local fire department responded and noticed symptoms of right sided weakness, facial droop, and slurred speech. Kadlec Regional Medical Center was pre-notified by the fire department. The emergency department consulted with a telestroke physician and the patient was taken directly to imaging. The telestroke physician reviewed the patient scans which revealed a large vessel occlusion needing a mechanical Thrombectomy to extract the clot, so the recommendation was made to transfer him to Sacred Heart Medical Center in Spokane, WA, for intervention. The patient was flown Sacred Heart Medical Center where he was taken directly to imaging for advanced scanning of his head. He was then taken for a Thrombectomy procedure under anesthesia, after which he was admitted to the ICU for recovery. Because of the tightly coordinated care he received, today he is able to move all extremities with minimal speech difficulties.

1st Quarter 2019

• AHA Market Insights Report: Telehealth Strategy
• Fierce Health | As telehealth tech explodes in use, can medicine preserve the human touch?
• Washington Post | The Health 202: Hospitals lean into virtual health care even as medicare won't cover it
• Part 2: Washington Post | The Health 202: Why Congress isn't expanding virtual health care
• HealthCare Finance News | Hospitals are turning to telehealth to manage scarce physician resources

Kadlec helps rural hospitals expand care through telemedicine

Kadlec Regional Medical Center, Providence Affiliate in the Tri-Cities, WA airs a weekly TV program called Community Health Journal on the local CBS affiliate. Recently, the Kadlec team visited Dayton to showcase the telemedicine services available in southeastern Washington region. Dayton is a critical access hospital about 70 miles from Kadlec, and relies on its relationship with Kadlec and Providence to connect specialty care to this rural part of the northwest. Please see the simulated Telestroke consult highlighting Dr. Todd Czartoski, Telestroke Neurologist and CEO of System Telehealth collaborating with Dr. Lewis Neace, ER Medical Director at Dayton General Hospital on a potential stroke patients timely care.

Read more in Tri-City Herald

View more from Community Health Journal

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