ABSTRACT
Background: The COVID-19 pandemic has dramatically accelerated the utilization and acceptance of telepsychiatry, with many departments transitioning to virtual models over the past 2 years out of necessity. While there has been some research on physician and patient satisfaction with the transition, there has been significantly less research on the quality of care provided (Mishkin). By its nature, telemedicine precludes physical examination. While many psychiatric conditions are amenable to diagnosis via patient interview alone, some such as catatonia require a physical exam for diagnosis. The Busch Francis Catatonia Rating Scale (BFCRS) is a well validated in-person exam for catatonia to both screen for and rate the severity of a catatonia diagnosis (Sienaert), but to our knowledge it has not been validated via telemedicine. Our literature review revealed a paucity of research on the contribution of each individual item to the overall sensitivity of the rating scale, thus it is impossible to predict the value of a fully virtual or hybrid exam. We plan to evaluate the inter-relater reliability between an in-person BFCRS performed by a psychiatrist and one supervised by a psychiatrist through telemedicine technology. Current practice at our institution is for the psychiatry resident performing tele-consults to Methods: We will draw participants from the pool of patients for whom psychiatric consults are ordered at two separate medical campuses. Our team will consist of C-L psychiatry fellows performing BFCRS exams patients at these campuses;we will strive to see all patients for whom a psychiatric consultation is ordered. In addition to a standard psychiatric consult (which may or may not include a BFCRS), patients will receive an in-person BFCRS screening exam performed and scored by the research team member at their site and one additional hybrid BFCRS exam scored by the research team member at the alternate site with physical exam components only performed by the onsite research team member. Data collected for each participant will include demographic information, medical and psychiatric diagnoses and BFCRS scores. We will compare the sensitivity and specificity fully virtual (which will by necessity exclude some components such as rigidity) and hybrid BFCRS exam to the full in-person scale, which we will treat as a gold standard. Discussion/Conclusion: This project is currently in early stages. We hope to gather data to inform the future practice of C-L psychiatrists performing consults through telemedicine. Mishkin AD, Cheung S, Capote J, Fan W, Muskin PR. Survey of clinician experiences of telepsychiatry and tele-consultation-liaison psychiatry. J Acad Consult Liaison Psychiatry. Published online November 15, 2021:S2667-2960(21)00184-1. Reference: Sienaert P, Rooseleer J, De Fruyt J. Measuring catatonia: a systematic review of rating scales. J Affect Disord. 2011;135(1-3):1-9 Copyright © 2022