Adapting to the digital age in psychiatry: evaluating change in emergency department nurses and psychiatrists’ views toward telepsychiatry for involuntary hospitalization

IntroductionImplementing change in organizations is challenging, and a key factor in success is the perception of the implementers. While many studies report on implementers’ perceptions as barriers or facilitators for implementing innovations, they often do not examine how these perceptions change over time. We aimed to evaluate changes in perceptions among nurses and psychiatrists in emergency departments (EDs) regarding the implementation of telepsychiatry (live video) for involuntary hospitalization.MethodsThis study utilized quantitative and qualitative methods, administering an online questionnaire to nurses and psychiatrists in eight EDs in Israel before and after telepsychiatry implementation. The questionnaire included: 1. Background characteristics (i.e., role and seniority); 2. SHEMESH questionnaire (“Organizational Readiness to Change Assessment”) comprising 11 items about the evidence for telepsychiatry, its feasibility, its effectiveness compared to face-to-face evaluation, and items about how supportive the ED environment for implementing changes in practice; 3. Two open-ended questions about how telepsychiatry would fit patients and the challenges in using telepsychiatry for involuntary commitment. Quantitative data were analyzed using descriptive statistics, t-tests, and regression models, while qualitative data were analyzed and categorized.Results344 participants completed the questionnaire (54% from the pre-implementation phase and 46% from the telepsychiatry phase). Both phases showed high scores on the overall Evidence construct, indicating that telepsychiatry is evidence-based, with an increase from the pre-implementation to the telepsychiatry phase. High scores on the overall Context construct were also observed, with no difference between phases. A regression model identified study phase, psychiatrists, and management team as predictors of higher Evidence and Context scores. Respondents’ comments in the pre-implementation phase focused on concerns about feasibility, while comments in the telepsychiatry phase focused on patient cooperation and agitated patients. Questions about professionalism arose in both phases. Overall, negative responses decreased significantly during the telepsychiatry phase, while perceptions of telepsychiatry’s fit for patients increased, though not statistically significantly.DiscussionOngoing use of an innovation over time can result in a favorable change in implementers’ perceptions as they grow accustomed to the innovation and appreciate its advantages, such as increased efficiency and improved results.
Clinical Trial registrationClinicalTrials.gov identifier: NCT05771545, March 15, 2023.