Optimizing ED care with tele-psychiatry, tele-neurology

Behavioral health crises and acute neurologic emergencies have placed immense pressure on EDs nationwide. Patients are waiting longer than ever, and frontline teams are stretched thin. To optimize emergency department care, we must think beyond traditional staffing models. In this context, tele-psychiatry and tele-neurology have emerged as game-changers – innovations that are redefining access to care, expanding capacity, and improving patient flow when seconds count.

A crisis of access and capacity

It’s no secret that EDs are overwhelmed. A recent poll by the American College of Emergency Physicians found that 90 percent of emergency physicians report crowding and boarding to be a serious problem, and nearly half of Americans have personally experienced or witnessed excessively long ED waits.

One major driver of these delays is the inability to secure timely specialist consultations. Take mental health emergencies: patients in severe psychiatric distress often board in the ED for hours or even days due to the nationwide shortage of psychiatrists. More than 150 million Americans live in areas lacking adequate mental health professionals, and finding an on-call psychiatrist at 2 a.m. is a daunting challenge for many hospitals.

This can compromise care for all ED patients. A patient arriving with stroke symptoms needs a neurologist’s expertise immediately, yet not every hospital has a neurologist standing by – and many community and rural hospitals have no neurologist at all on staff. This mismatch between patient needs and available specialists underpins an access crisis that directly impacts ED throughput and outcomes.

Across the country, access to care is not limited only to conditions surrounding neurology and mental health. We should consider how adding specialty care to local hospitals can expand access to care and drive ED optimization alongside the benefits of inpatient volume, case mix index, and revenue.

Telehealth as a turning point

Telehealth, specifically telemedicine programs in psychiatry and neurology, is changing the equation for ED care. Tele-psychiatry in the ED means that a psychiatrist is always on call. Within minutes, a patient in a manic episode or severe depression can be assessed via secure video and started on a treatment plan.

The impact on flow is dramatic: Rather than awaiting evaluation, patients start receiving care and can either be admitted to an appropriate psychiatric facility or safely discharged with a plan. Tele-psychiatry consults can drastically reduce ED length of stay for behavioral health patients, primarily by cutting down wait times for specialist input. The ED staff, in turn, can refocus on other acute medical cases, knowing the psychiatric needs are being handled promptly.

Tele-neurology (tele-stroke) has an equally powerful effect. In stroke care, we live by the mantra “time is brain.” When a patient arrives with a possible stroke, the clock is ticking to assess and deliver clot-busting medication (tPA) or other interventions. Through tele-neurology, stroke neurologists are virtually at the bedside within moments of a call. They review the CT scans in real-time, talk the team through the neurologic exam, and help decide if thrombolytic therapy is warranted – often all within the critical window for treatment.

This speed can be lifesaving. Research published in Telemedicine and e-Health demonstrated that hospitals in a telestroke network cut their door-to-needle time by more than 30 minutes on average (from 112 minutes down to 81 minutes), meaning patients were treated significantly faster. For the patient, it’s seamless – they feel as if the specialist is in the room (because, via camera, they practically are) – and for the local clinicians, it’s a massive relief to have expert backup during high-stakes decisions.

Better outcomes, better flow

The ripple effects of integrating tele-psychiatry and tele-neurology in the ED go beyond individual cases. When you can rapidly resolve a psychiatric emergency or expedite stroke treatment in-house, you free up ED resources more quickly. This translates to shorter wait times in the lobby, more capacity for new incoming patients, and less likelihood of hallway boarding.

It also improves staff morale – clinicians know they can deliver the care their patients need without scrambling for referrals in the middle of the night. Moreover, patients receive definitive care faster, which improves outcomes and satisfaction. A stabilized behavioral health patient can be transferred to a psych unit (or connected with outpatient services) hours earlier than before.

A stroke patient who gets tPA within 45 minutes of arrival is more likely to walk out of the hospital with minimal deficits. These success stories reinforce that telehealth isn’t just a tech experiment; it’s a strategic necessity for modernizing emergency care. Notably, tele-stroke programs have been shown to reduce the geographic and racial disparities in stroke treatment by bringing expertise to underserved areas. Tele-psychiatry, likewise, extends the reach of scarce specialists, offering rural and inner-city hospitals alike a way to deliver mental health care on par with the nation’s best centers.

Leadership and collaboration

When implementing telehealth solutions, it is essential to integrate them into ED team culture. Virtual consultants must function as part of the care team, not as disconnected, remote observers. They’re integrated into workflows, aligned on protocols, and just as invested in the patient’s outcome as anyone on site. Whether it’s triaging a behavioral health call or activating a stroke alert, the communication is seamless, the response immediate.

It’s also crucial to monitor metrics like consult response times, ED length of stay for telehealth cases, and clinical outcomes. The data consistently shows improvement, which helps maintain executive buy-in and frontline enthusiasm. Involving physicians in reviewing results is key; they can see the tangible difference tele-specialists make, whether it’s a jump in tPA administration rates or a drop in the average boarding time.

A new standard for emergency care

Tele-psychiatry and tele-neurology are proving their value as indispensable tools in the effort to optimize emergency department care. They directly address the pain points of access, capacity, and flow that challenge EDs everywhere. By having the right expertise in the right place at the right time virtually, we ensure that no patient has to wait for high acuity care, and no provider has to face a complex emergency alone.

Hospitals that have embraced telehealth in the ED are seeing the difference – measured in faster treatments, lives saved, and a less chaotic patient experience. It’s a transformation that will soon become the new standard of emergency medicine. Our goal at Equum Medical is to make sure that standard is within reach of every hospital, large or small. Because when the moment is critical — when seconds count — virtual care is not a convenience. It’s a lifeline.

NRHA adapted the above piece from Equum Medical, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.

About the author: Dr. Anisha Mathur is the chief medical officer at Equum Medical, where she leads clinical innovation and virtual care strategy across critical care, multispecialty, and hospitalist services. Triple board-certified in internal medicine, infectious diseases, and critical care, Mathur brings deep expertise in tele-ICU and rural health care delivery. She has implemented scalable telehealth programs that improve access, reduce avoidable transfers, and support frontline clinicians in underserved communities.