# Improving Teletherapy Enrollment Using Quality Improvement Methodology for Psychiatry Patients Boarding on Acute Care Services

## TL;DR

A hospital improved access to teletherapy for psychiatric patients by implementing a new workflow and using quality improvement methods.

## Contribution

A novel teletherapy program was developed and sustained for acute care patients awaiting psychiatric admission.

## Key findings

- The median number of patients receiving teletherapy orders increased from 2 to 4 per month.
- The improved teletherapy enrollment was sustained for 5 months after three Plan-Do-Study-Act cycles.
- Multidisciplinary coordination and EHR enhancements were key to achieving and maintaining the increase.

## Abstract

In 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association declared a state of emergency in children’s mental health. Responding to this emergency, our freestanding children’s hospital began a novel teletherapy program to provide teletherapy services to patients admitted to acute care units while awaiting inpatient psychiatric care. The global aim of this quality improvement project was to improve access to inpatient teletherapy. The specific aim was to increase the number of patients who completed at least 1 teletherapy session from a median of 2–4 per month and sustain this increase for 3 months.

Using the Model for Improvement framework, multidisciplinary stakeholders created process maps and Ishikawa diagrams, followed by key driver diagrams, to outline areas for improvement in the teletherapy enrollment process. Interventions included staff education, improved communication techniques, and enhancements to the electronic health record (EHR). We implemented interventions as Plan-Do-Study-Act cycles, collected data via a custom EHR report, and analyzed data using a run chart.

After completing 3 Plan-Do-Study-Act cycles, the median number of patients with teletherapy orders increased from 2 to 4 per month, a level we sustained for 5 months.

Implementing and sustaining a novel group teletherapy workflow on acute care units is a multidisciplinary and complex process that requires multistakeholder coordination. We achieved a sustained increase in teletherapy enrollment through staff engagement, team member education, and EHR clinical decision support.