D.27 Butler Telehealth Emergency Response SOP.docx

Butler VA Health Care System 353 Duffy Rd.

Butler, PA 16001

DATE: 05/04/2020

SUBJECT: Telehealth Emergency Response and Crisis Intervention Procedure ______________________________________________________________________

1. PURPOSE: To outline the management and process related to medical and behavioral health emergency response procedures for all staff providing telehealth services.

2. POLICY: Staff will follow a consistent process in arranging for clinically appropriate emergency care for patients presenting to telehealth appointments with a medical or behavioral health emergency. Staff will assess patient risk and coordinate clinically indicated transfer or follow-up care with patient site staff or local services. Staff will follow the patient site/local facility policy for emergency response and crisis intervention.

3. PROCEDURES: Emergency procedures are addressed in the Telehealth Service Agreement and facility guidance documents. It will be necessary for the Connected Care Manager to provide the clinician with the Telehealth Service Agreement that contains all the emergency information. To facilitate communication in emergency situations, a phone must be available in the telehealth room for the provider to support the patient if an emergency arises. Alternative forms of communication must be available for patient and provider sites to connect immediately. Some of these alert mechanisms may include cell phones, pagers, panic buttons and electronic medical record alerts, etc. It is also important to proactively provide patients engaging in telehealth care with options to reach the Veterans Crisis Line (i.e., phone, 1-800-273-8255, press 1; text 838255; and chat), so they can receive crisis support at any time.

1. Clinic-Based Clinical Video Telehealth Mental Health Emergency: Before all clinic-based CVT visits, the telehealth provider and TelePresenter must have readily available the Emergency Plan Contact List, including the key patient and provider site points of contact. In the event a patient is assessed by a provider and deemed to be in imminent danger to self or others the provider will contact the patient site and initiate the patient site policy for emergency Mental Health response:

a) Provider will contact the TelePresenter via instant messaging, Skype call, and/or TelePresenter emergency phone.

b) If no response, provider will follow the patient site emergency contact form for the patient site.

c) The patient site TelePresenter/Clinical POC and local staff will collaborate to ensure that an on-site staff member is present in the room with the patient for added support while awaiting transfer or other appropriate clinical disposition.

d) Telehealth provider will work with patient site staff to ensure appropriate transfer, follow-up care, and notification of appropriate patient site staff members [e.g., Onsite Licensed Independent Practitioner (LIP), Disruptive Behavior Committee, Crisis Team, Veteran Affairs (VA) Police, and/or Suicide Prevention Coordinator].

e) Patient site Clinical POC (LIP) will complete necessary paperwork and arrange for transfer to local hospital. If there is not a local LIP available at the patient site, the patient site staff will contact the local emergency personnel.

f) After the behavioral health emergency has been resolved, the telehealth provider will document the incident, assessment, and plan in the patient electronic health record (patient side) and will assign appropriate team members as additional signers to the note.

2. Clinic-Based Clinical Video Telehealth Medical Emergency: Before all clinic-based CVT visits, the telehealth provider and TelePresenter must have readily available the Emergency Plan Contact List, including the key patient and provider site points of contact. If the patient is assessed by the provider and deemed to be experiencing a medical emergency, the provider will contact the patient site and initiate the patient site policy for emergency medical response:

a) Provider will contact the TelePresenter via instant messaging, Skype call, and/or TelePresenter emergency phone.

b) If no response, provider will follow the patient site emergency medical plan.

c) The telehealth provider will work with patient site staff to ensure appropriate transfer, follow-up care, and notification of patient site staff members.

d) After the medical emergency has been resolved, the telehealth provider will document the incident, assessment, and follow-up plan in the patient’s electronic medical record (patient side) and will assign appropriate team members as additional signers to the note as indicated.

3. Clinical Video Telehealth to Home or Non-VA location/ VA Video Connect Mental Health or Medical Emergency:

To promote safety, all telehealth visits to the home or other non-VA location require certain information and resources to be obtained/verified at the start of the actual encounter and documented in the medical record, including:

a) The Veteran’s phone number

b) The Veteran’s present location and address

c) The Veteran’s emergency contact name and phone number (if available)

d) Ensuring the Veteran is in a private/confidential location

e) Asking if there are other individuals present with the patient, and if so, getting the name and contact information for the individual(s)

f) Contact information for local emergency services (e911)

If the patient is assessed by the provider and deemed to be in imminent danger to self or others or experiencing a medical emergency, the provider will utilize one of the following as appropriate:

(1) Provider will follow their local CVT into the home/VA Video Connect Emergency Plan.

(2) Provider will contact e911: E911 is a service that providers can use to be routed to emergency dispatch services in the Veteran’s area.

To use E911, the provider first dials the E911 center also known as the Emergency Call Relay Center at 267-908-6605 and relays the Veteran’s location — including the street address, city, state, and ZIP code.

(3) The telehealth provider will work with patient site staff (if non-VA care site) and/or caregivers to ensure appropriate transfer, follow-up care, and notification of patient site staff members.

(4) After the mental health or medical emergency has been resolved, the telehealth provider will document the incident, assessment, and follow-up plan in the patient’s electronic medical record (patient side) and will assign appropriate team members as additional signers to the note as indicated.

If the patient is assessed by the provider to not be in imminent danger to self or others the following steps will be taken:

(a) Ensure patient has a follow-up appointment with an appropriate provider.

(b) Provide the patient with the Veterans Crisis Line number (1-800-273-8255, press 1).

(c) Telehealth provider will document appointment, assessment, and follow-up plan in the patient’s electronic health record (patient side) and will assign appropriate team members as additional signers to the note.

4. RESPONSIBILITIES:

a. Telehealth Providers. Staff are responsible for recognizing a medical or behavioral health emergency situation and initiating the emergency response procedures as defined in this SOP. Patients will be treated with dignity, privacy, and respect, with an emphasis on recovery and building positive relationships. Staff will provide interventions and services that are consistent with the Veteran’s needs. Telehealth providers will document in accordance with VA policy and notify their supervisor.

b. Medical Center Leadership. Medical Center leadership are responsible to ensure the emergency response procedures are instituted for each patient site that receives telehealth services and that each plan is reviewed and tested at least every year to ensure emergency procedures function properly and are updated as needed.

c. Patient Site TelePresenter. TelePresenter or designee at patient site is responsible for answering phone and/or instant messaging or Skype calls and coordinating with the telehealth provider to initiate clinically indicated care for the Veteran which is consistent with local (patient site) and national policies. In an urgent situation, the TelePresenter is expected to be aware of the emergency plan that dictates the course of action, including what points of contact should be notified according to the situation. To facilitate this, the TelePresenter should have access to a phone within or immediately adjacent to the patient room.

d. Patient Site Leadership. Will be responsible for ensuring an emergency standard operating procedure is outlined at the patient site, patient site staff are aware of these emergency operating procedures and respond to the medical or behavioral health emergency with actions that are clinically appropriate, administratively efficient, and consistent with local and national policies.

5. REFERENCES:

VHA HANDBOOK 1160.01 (Uniform Mental Health Services in VA Medical Centers and Clinics)

Connected Care Telehealth Manual

VVC Supplement

Telemental Health Supplement

TMH Emergency Procedures Template

VA Video Connect Provider Guidance – Emergency Procedures.

6. RESPONSIBILITY: It is the responsibility of the Emergency Management Specialist and the Connected Care Manager to ensure that employees are familiar with this policy.

7. REVIEW DATE: This SOP will be reviewed ANNUALLY or sooner as necessary [October 2021] Emergency Plan Contact List will be reviewed EVERY 6 MONTHS and as necessary.