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Completed

NCT Number: NCT04148521

A Virtual Navigation Intervention to Reduce Behavioral Health Admissions From Rural Emergency Departments

This research project is a pragmatic, randomized evaluation of a quality improvement initiative which seeks to evaluate the effects of standardizing the use of a BH-VPN program among patients with a telepsychiatric consult. The outcomes evaluation of this intervention has been designed to integrate with routine care and minimize frontline staff burden by deploying an evaluation in a real-world setting.

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Key information

Conditions

Depression Anxiety Anxiety Disorders Behavior Behavioral Symptoms Chemically-Induced Disorders Mental Disorders Substance Use Disorders Substance-Related Disorders

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Atrium Health - Stanly, Albemarle, North Carolina, United States

Loading trial locations.

About this study

Hospital admissions are common amongst those with mental illness. Significant morbidity exists for patients who are being admitted to a psychiatric hospital from the Emergency Department (ED).Additionally, commitment to a hospital setting may have adverse effects on patients psychologically, degrade relationships with therapists, and disrupt continuity of care. ED providers often decide to admit to a psychiatric hospital because of limited availability of behavioral health resources. To better enhance transitions of care for those with mental illness, Atrium Health has designed a behavioral health virtual patient navigation (BH-VPN)program that helps coordinate services and follow-up care, while facilitating the safe discharge of patients. Patients presenting to an ED that have a tele psychiatric consult who are recommended for discharge are eligible for services. The Behavioral health Service line is expanding the program to additional rural emergency departments. Using an outcomes evaluation, the investigators will inform Atrium Health on the effect of the BH-VPN program to reduce hospital admissions among patients with a tele psychiatric consult in the ED. The proposed hypothesis is that by having the BH-VPN program available in an ED, more patients will be discharged from the ED than admitted.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Eligible patients must meet each of the following criteria:

  • Present to an ED at participating sites
  • Complete a telepsychiatric consult as captured in the electronic medical record
  • Complete a telepsychiatric consult during the navigator's hours of operation
  • ≥ 18 years of age at time of ED admission

Exclusion criteria

• Patients currently enrolled in the BH-VPN program upon their index ED encounter

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Treatment and study plan

Behavioral Health - Virtual Patient Navigation

Behavioral

Patients are identified by a clinician in the ED as needing psychiatric evaluation and a referral is made to a tele-psych provider for a virtual consult. Patients can be enrolled to the intervention arm based on a randomization scheme that randomly allocates days that navigators are available. The psychiatrist will make a recommendation to admit or discharge the patient. For patients that have a discharge recommendation on days that BH-VPN is available, patients will be offered the BH-VPN program. Enrolled patients are followed for up to 45 days. On days where the navigator is available, all patients who meet eligibility criteria will be considered exposed to the intervention.

Primary outcomes

  1. Assessing Hospital Admissions

    Time frame: Up to 2 weeks from initial ED admission

    Compare the effectiveness of having the Behavioral Health - Virtual Patient Navigation (BH-VPN) program available compared to usual care, on admission rates among patients in the ED with a telepsychiatric consult

Secondary outcomes

  1. 45-day Post Discharge Utilization Rate

    Time frame: 45 days

    Comparing the 45-day utilization (ED, IP, OBS encounter) rate after the ED encounter between the 2 arms of the study

  2. 45-day Post Discharge Utilization Rate With a Self-harm Diagnosis

    Time frame: 45 days

    Compare the frequency of patients with any encounter with a self-harm diagnosis within 45 days of the ED visit between the 2 arms of the study

  3. 45-day Post Discharge ED Utilization Rate With a Behavioral Health Crisis

    Time frame: 45 days

    Compare the frequency of patients who return to the ED and have a telepsychiatric consult within 45 days of their initial ED visit between the 2 arms of the study

Sponsors and collaborators

Lead sponsor

Wake Forest University Health Sciences

Other

Collaborators

  • The Duke Endowment

Registry information

Official study title

A Virtual Navigation Intervention to Reduce Behavioral Health Admissions From Rural Emergency Departments (VIBRANT)

Acronym: VIBRANT

Important dates

Study start
2019
Primary completion
2021
Study completion
2022
First posted
Nov 1, 2019
Registry last updated
Mar 21, 2023

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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