Innovative program speeds, expands psychiatric response

Call FIRST member Tammy Boudreaux, LMSW, can assess mentally ill patients in area emergency rooms using this remote monitoring station at the Memorial Hermann Healthcare System's corporate headquarters.

HOUSTON, Texas, July 24, 2005 – Desperation marks mental health crises. When people find their lives in turmoil, when they reach mental or emotional breaking points, they often can't find the help they need due to limited emergent/urgent care resources in the community. For many patients, their only option is a medical emergency room.

Thanks to a first-in-Texas electronic mental health interview system for emergency departments, Memorial Hermann Healthcare System's psychiatric response team can help a growing number of Houston-area patients get the help they need.

Twenty-one mental health professionals make up Call FIRST (Fast Intervention, Referrals and Stabilization Team). Advance-practice nurses, master's-prepared social workers and psychiatrists are available around the clock to respond to calls from 16 emergency rooms.

“The team was developed with the mission of taking care of psychiatric patients compassionately and efficiently,” explained Theresa Fawvor, LCSW, team manager.

Team members assess, refer and transfer patients to the most appropriate level of psychiatric care in the community. They can also expedite appointment scheduling with private doctors. In addition to serving Memorial Hermann Hospitals, Call FIRST contracts with other facilities in the region.

“In the mid-1990s, there were about 3,000 in-patient psychiatric beds in the Houston area. Now there are only 914 between Huntsville and Galveston ,” explained Fred Ramirez, MSN, APRN , BC , director of Call FIRST. This shortage of mental health services in Houston makes the team's work even more vital.

“Fortunately, most patients assessed by Call FIRST do not need in-patient treatment, but they visit emergency rooms as a last resort while in a crisis situation. Unfortunately, they may wait several hours before seeing on-call psychiatric professionals,” Ramirez added.

The mobile team responds within half an hour while covering approximately 3,500 square miles, from The Woodlands to Webster. This team can move patients out of emergency rooms within 2½ hours, and the new technology facilitates even faster patient disposition.

With the support of his colleagues, Manish Pandya, LCSW, spent months researching programs around the nation to develop the protocols used in Memorial Hermann's innovative electronic mental health program.

The Call FIRST team members communicate with patients and ER staff using televisions and video cameras. The clinicians are stationed at corporate headquarters and use tele-video equipment to interview patients in distant emergency rooms. The patients and clinicians can see and hear each other.

“People who are violent or delusional may require in-person visits, but an estimated 80-90 percent of assessments could be handled via telemedicine,” Ramirez said.

“For some patients, remote assessment offers advantages over in-person visits,” Pandya noted. The camera's zoom allows Call FIRST members to observe an individual more closely without causing the patient additional concern. “The distance allows the patient to feel a little calmer. It's less imposing,” Pandya explained.

Initially, the system linked Call FIRST's corporate office with ERs at Memorial Hermann Hospital and Memorial Hermann Southwest Hospital , where the necessary equipment was already in place to serve a stroke telemedicine program. Within the year, units will be added at six other Memorial Hermann hospitals.

Through remote assessment, Call FIRST is also extending its reach beyond the area team members can cover in person. Agreements have been signed with Angleton Danbury Medical Center , which is 42 miles south of Houston , and Yoakum Community Hospital , which is 75 miles southeast of Houston . Call FIRST expects to add service to additional outlying facilities in the future.

“We should start seeing patients in Angleton and Yoakum in July and August, respectively,” Ramirez said. “Remote assessment will allow patients in those towns to get help quickly, and they can be treated in their home counties instead of traveling to Houston .”

Other leaders of rural community based clinics have already expressed interest in the program. “Rural communities are seeking our expertise in providing assessment and effective referrals for patients with mental health needs. Once we establish the success of our electronic mental health program, we will be able to solidify funding for future collaborations with community-based clinics in our area,” states Ramirez.

For more information, contact Media Relations.