Background: Reducing Length of Stay (LOS) is an important way for hospitals to improve emergency department (ED) costs and outcomes. Psychiatric patients represent a challenge to reducing LOS as the scarcity of psychiatric specialists leads to longer LOS. Previous literature describes the unique solutions different hospitals have employed across the US, but does not give methods for evaluating or selecting a solution that can be applied to other hospitals. Methods: A mixed methods exploratory sequential design was retrospectively registered in order to build and subsequently test a contextually appropriate evaluation framework. First, interviews with hospital staff were conducted in a qualitative phase, the results of which were used to develop an evaluation framework as a quantitative instrument. This evaluation framework was subsequently tested using a large sample of observational ED case data from one community hospital, as well as pricing data resulting from market research on psychiatry services. This information, along with projected return on investment, was aggregated to create a holistic model for evaluating different telepsychiatry service options and selecting the one with the best fit. Results: Our methodology identified 8 key factors that captured the overall difficulty of implementation and benefits associated with each service option. These factors were used to develop a prioritization model that identifies the one psychiatric service improving psychiatric LOS and best fitting the hospital’s overall priorities and operations. Conclusion: The Prioritization Model created in this study was instrumental in selecting the solution for reducing LOS in a way that best meets patients’ and hospitals’ needs. This model may be applied to other hospitals in the U.S. to provide a holistic review and direct comparison of opportunities.
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