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The goal of this observational study is to examine the effect of using a video link for evaluation of patients in the psychiatric emergency room. Under current Israeli law, the attending physician must come in to physically examine the patient before they can be admitted involuntarily. Patients often de-compensate and even may become violent while waiting for the attending to arrive. Previous studies have shown that evaluation of such patients via video-link has an extremely high concordance with in person evaluation. This study will compare patients who are evaluated via video-link with historical controls evaluated under usual conditions. This is an observational study, which is taking advantage of a change in practice to collect data on two different ways of delivering care, via chart reviews. If successful, this study will show that the video-link is feasible and acceptable to patients and staff. The following hypotheses will be tested:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Pre-Innovation (Usual Care) | Patients evaluated in the psychiatric emergency department for possible involuntary admission during the year prior to the innovation in care. During this period, the attending psychiatrist was required to physically come to the hospital to examine the patient. | ||
| Innovation (Tele-Psychiatry) | Patients evaluated in the psychiatric emergency department for possible involuntary admission during the innovation period. Instead of physically coming to the hospital, the attending physician will evaluate the patient via video-link, which will be facilitated by the on-site psychiatric resident. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Telepsychiatry | Other | Instead of coming to the hospital physically, the attending psychiatrist will evaluate the patient via a video-link. |
|
| Measure | Description | Time Frame |
|---|---|---|
| ED Time | Amount of time, in hours and minutes, that the patient spends in the ED prior to disposition | Patients arrive in the ED at a specific time and leave the ED at a specific time. We will compute the amount of time spent in the ED by each patient, up to two weeks. |
| Measure | Description | Time Frame |
|---|---|---|
| Violent Incidents | Adjudicated violent incidents that occur, whether in the ED or on the psychiatry ward. Includes hitting, kicking, throwing, and property destruction | Patients arrive in the ED at a specific time. Those who are admitted are eventually discharged. Violent incidents can occur during the entire time spent in the hospital, whether in the ED or on the ward, up to 90 days total. |
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Inclusion Criteria:
Exclusion Criteria:
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All patients who are evaluated for involuntary psychiatric admission via the ED, who meet the above criteria.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| HaEmek Medical Center | Afula | Israel | ||||
| Jerusalem Mental Health Center - Eitanim |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 42206074 | Derived | Shalev L, Lubin G, Kirresh S, Barash I, Tamary Guterman A, Bloemhof-Bris E, Hirschmann S, Avni A, Avirame K, Linder M, Bathish D, Badran R, Turm Y, Bloch B, Konas S, Izakson L, Asad F, Melamed Y, Raskin S, Raz D, Eitan R, Rose AJ. Adapting to the digital age in psychiatry: evaluating change in emergency department nurses and psychiatrists' views toward telepsychiatry for involuntary hospitalization. Front Digit Health. 2026 May 12;8:1810008. doi: 10.3389/fdgth.2026.1810008. eCollection 2026. | |
| 37847548 |
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It is not possible to share IPD because of data security concerns and the stipulations of the research ethics committees that are approving the study
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| ID | Title | Description |
|---|---|---|
| FG000 | Pre-Innovation (Usual Care) | Patients evaluated in the psychiatric emergency department for possible involuntary admission during the year prior to the innovation in care. During this period, the attending psychiatrist was required to physically come to the hospital to examine the patient. |
| FG001 | Innovation (Tele-Psychiatry) | Patients evaluated in the psychiatric emergency department for possible involuntary admission during the innovation period. Instead of physically coming to the hospital, the attending physician will evaluate the patient via video-link, which will be facilitated by the on-site psychiatric resident. Telepsychiatry: Instead of coming to the hospital physically, the attending psychiatrist will evaluate the patient via a video-link. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Pre-Innovation (Usual Care) | Patients evaluated in the psychiatric emergency department for possible involuntary admission during the year prior to the innovation in care. During this period, the attending psychiatrist was required to physically come to the hospital to examine the patient. |
| BG001 |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Customized | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | ED Time | Amount of time, in hours and minutes, that the patient spends in the ED prior to disposition | Posted | Median | Inter-Quartile Range | Minutes | Patients arrive in the ED at a specific time and leave the ED at a specific time. We will compute the amount of time spent in the ED by each patient, up to two weeks. |
|
Through hospital discharge or discharge from the emergency department
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Pre-Innovation (Usual Care) | Patients evaluated in the psychiatric emergency department for possible involuntary admission during the year prior to the innovation in care. During this period, the attending psychiatrist was required to physically come to the hospital to examine the patient. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Adam Rose | Hebrew University of Jerusalem | +972-55-500-1040 | adam.rose@mail.huji.ac.il |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Nov 5, 2021 | Jan 7, 2026 | Prot_SAP_000.pdf |
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| Hospital Length of Stay | Length of stay, in days, starting with time of arrival to ED | For patients admitted to the hospital through the ED, the beginning time is their arrival to ED, the end is the time of hospital discharge, up to 90 days later. |
| Jerusalem |
| Israel |
| Jerusalem Mental Health Center | Jerusalem | Israel |
| Shaar Menashe Psychiatric Hospital | Pardés H̱anna Karkur | Israel |
| Geha Psychiatric Hospital | Petah Tikva | Israel |
| Ziv Medical Center | Safed | Israel |
| Tel Aviv Sourasky Medical Center | Tel Aviv | Israel |
| Lev Hasharon Mental Health Center | Tsur Moshe | Israel |
| Derived |
| Shalev L, Bistre M, Lubin G, Avirame K, Raskin S, Linkovski O, Eitan R, Rose AJ. Enabling Expedited Disposition of Emergencies Using Telepsychiatry in Israel: Protocol for a Hybrid Implementation Study. JMIR Res Protoc. 2023 Oct 17;12:e49405. doi: 10.2196/49405. |
| Innovation (Tele-Psychiatry) |
Patients evaluated in the psychiatric emergency department for possible involuntary admission during the innovation period. Instead of physically coming to the hospital, the attending physician will evaluate the patient via video-link, which will be facilitated by the on-site psychiatric resident. Telepsychiatry: Instead of coming to the hospital physically, the attending psychiatrist will evaluate the patient via a video-link. |
| BG002 | Total | Total of all reporting groups |
| Participants |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race/Ethnicity, Customized | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
|
|
| Secondary | Violent Incidents | Adjudicated violent incidents that occur, whether in the ED or on the psychiatry ward. Includes hitting, kicking, throwing, and property destruction | Posted | Count of Participants | Participants | Patients arrive in the ED at a specific time. Those who are admitted are eventually discharged. Violent incidents can occur during the entire time spent in the hospital, whether in the ED or on the ward, up to 90 days total. |
|
|
|
| Secondary | Hospital Length of Stay | Length of stay, in days, starting with time of arrival to ED | Only those who were admitted to hospital; does not include those discharged from the Emergency Department | Posted | Median | Inter-Quartile Range | days | For patients admitted to the hospital through the ED, the beginning time is their arrival to ED, the end is the time of hospital discharge, up to 90 days later. |
|
|
|
| 0 |
| 525 |
| 0 |
| 525 |
| 0 |
| 525 |
| EG001 | Innovation (Tele-Psychiatry) | Patients evaluated in the psychiatric emergency department for possible involuntary admission during the innovation period. Instead of physically coming to the hospital, the attending physician will evaluate the patient via video-link, which will be facilitated by the on-site psychiatric resident. Telepsychiatry: Instead of coming to the hospital physically, the attending psychiatrist will evaluate the patient via a video-link. | 0 | 434 | 0 | 434 | 0 | 434 |
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