Researchers: Adam Rose¹, Renana Eitan², Gad Lubin², Moshe Bistre²

Background: While the use of video chat for psychiatry has become common, it has not been studied for involuntary admissions.

Objectives: To examine the impact of telepsychiatry in the psychiatric emergency room, compared to in-person evaluation.

Method: Seven hospitals implemented telepsychiatry evaluations for involuntary admission by the attending psychiatrist during off-hours, with in-person evaluation remaining an option. Clinical and administrative outcomes were compared between the intervention period and the same months the previous year.

Findings: During the pre-intervention period, 525 patients were evaluated in person. During the intervention period, 434 were evaluated, 44% in-person and 56% remotely. Patients evaluated in-person had more complicated presentations and a less-clear clinical picture. ED time was similar between control and intervention periods (2:13 vs. 2:06, p = 0.55). Violent incidents were similar across periods (21% vs. 22%, p = 0.31). Among patients discharged from the ED, the proportion who were admitted involuntarily within a week was similar (11% vs. 9%, p = 0.61). Among those admitted involuntarily, the proportion discharged within one week was similar (19% vs. 15%, p = 0.40). Length of stay was not significantly different (29.4 vs. 34.6 days, p = 0.19). Due to concern about imbalanced samples, we repeated these analyses after propensity matching; results were unchanged.

Conclusions: Given the opportunity to evaluate patients remotely for involuntary admission, attending psychiatrists still chose to evaluate 44% in person, apparently due to clinical considerations. There was no evidence to suggest that patient care was adversely impacted by telepsychiatry.

Recommendations: Attending psychiatrists, given the option to evaluate patients remotely for involuntary admission, are able to determine which patients can be evaluated remotely and which should be evaluated in-person. Allowing the possibility of remote evaluations is well-received by clinical staff and does not harm patient care in any measurable way.

Research end date: 01/2026