Patient Safety and Emergency Management in Telepsychiatry with Children and Adolescents
Daniel Alicata, MD, PhD, DFAACAP 

• Traditional health-care settings, such as hospitals and community mental health centers, typically have infrastructure and emergency management protocols in place that can be adapted to telepsychiatric care.
• Non-traditional health care settings, such as shelters for families and children may not yet have established emergency management infrastructure and protocols. Psychiatrists telecommuting to any setting must consider whether appropriate emergency management protocols are in place and develop any needed protocols.
• Emergency management during telepsychiatry is a team effort, and telepsychiatrists, in conjunction with patient-site collaborators, should discuss whether and how the patient site utilizes the local community’s emergency resources.
• Telesychiatrists managing emergencies must rely on a team of individuals. On-site staff must be identified who can help by physically intervening during the emergency.  Community resources must be identified to incorporate into emergency management protocols and the patient’s system of care.
• Safety and mobilization procedures at a patient site should be both accessible to staff for review and an integral part of their training.
• Psychiatrists need to be able to effectively manipulate telepsychiatry technology in order to maximize video and audio quality to optimally assess signs of agitation, substance use, and medication side effects. If technology falters, psychiatrists should be prepared to quickly initiate a pre-planned backup emergency management plan.

References

1. Luxton DD, Sirotin AP, Mishkind MC. Safety of telemental healthcare delivered to clinically unsupervised settings: A systematic review. Telemedcine e-Health 2010;16: 705-711.
2. Shore J, Yellowlees PM. Emergency management guidelines for telepsychiatry. General Hospital Psychiatry 2007; 29(3):199-206.