14 - Using QI Methodology to Improve Enrollment in a Novel Teletherapy Program for Psychiatry Patients Boarding on Acute Care Services

Poster Number: 14
Publication Number: 14.2728

Background: The American Academy of Pediatrics has declared a national pediatric mental health emergency. In Washington, DC there are an increased number of pediatric patients with psychiatric concerns presenting for emergency care, and more patients on acute care services awaiting inpatient psychiatric care. A novel teletherapy program on the acute care units of an independent children’s hospital began in 2021. The program's goal is to provide group therapy services that would otherwise be unavailable to patients through telehealth links to inpatient psychiatry group therapy sessions while they await definitive psychiatric placement. The workflow for patient participation is multidisciplinary and complex.

Objective: The objective of this quality improvement project was to improve teletherapy enrollment on acute care services. The aim was to increase the number of patients who complete at least 1 teletherapy session in the teletherapy program from two patients per month to four by January 2024 and sustain this increase for 3 months.

Design/Methods: Using the Model for Improvement framework, key multi-disciplinary stakeholders from acute care nursing, inpatient and consult psychiatry, and hospital medicine were identified and a process map was completed to outline the workflow for teletherapy completion. The process measure was the number of patients with teletherapy orders placed. A Fishbone Diagram was used to identify areas for improvement which facilitated creation of a Key Driver Diagram. Interventions, including multi-modal education, improved communication techniques, and electronic health record solutions, were implemented as PDSA cycles. Data was gathered via a custom electronic health record report of all patients with an order placed for teletherapy per month, then evaluated via a run chart.

Results: Four PDSA cycles were completed. Prior to initiating PDSA cycles, the median number of patients with teletherapy orders was two patients per month (see Run Chart). After initiation of four PDSA cycles, the median number of patients increased to four patients per month.

Conclusion(s): Implementing and sustaining a novel group teletherapy workflow on the acute care services is complex and requires coordination between multiple different units and stakeholders. Through buy-in, education, and clinical decision support, there are several ways to improve patient enrollment. Next steps include meeting with stakeholders to identify additional areas for process improvement with subsequent PDSA cycles, and chart review to investigate the outcome measure of decreased overall hospital stays for teletherapy participants.