Slide 1

VCI Summative 9020: Checkpoint: Midway implementation

My privilege is to present the virtual check-in meeting on the topic of the telepsychiatry follow-up improvement program that will help improve continuity of psychiatric care through the standard protocol of reminders as per the Community Preventive Services Task Force (CPSTF) recommendations. It will focus its presentation on the growth of the project, the initial results of the implementation, as well as incessant rises in patient adherence to follow-up in the outpatient telepsychiatry clinic.

Slide 2

Introduction

Adherence follow-ups with patients (who underwent outpatient telepsychiatry services) have been the issue of concern and, therefore, demand constant attention, patient engagement, and continuous tracking. Telepsychiatry has also assisted in that now more individuals have a chance to obtain mental health services, and lastly, most of the patients are missing their follow-up appointments, leaving them at risk of relapse of their symptoms, non-compliance with medication, and mental crisis. Internal data collected within the practicum site revealed that a quarter of the patients in the setting attended their follow-up visits within 30 days, which is considerably lower than the national average of patients attending their follow-up care, being 50.7% (Simple Practice electronic health record data set, internal site, November 03, 2025). One of the significant contributing factors identified at the site was a lack of uniform reminder and follow-up process, which resulted in inconsistency in contacting the patients and continuity of care. The results also point to the idea that systematized systems of follow-ups in telepsychiatry, and automatic notification systems promote attendance and engagement in appointments and the patients (Medicaid.gov, 2026). Another suggestion made by Hugunin et al. (2023) is that the continuity of psychiatric care and the number of missed appointments may be significantly increased due to the introduction of electronic health records with reminder alerts and follow-up. The project will help close the gaps identified by incorporating an evidence-based standardized follow-up program of telepsychiatry, leveraging EHR-enabled reminder and nurse-coordinated interventions through follow-up.

Slide 3:

Key Concepts

The quality improvement initiative is built upon the evidence-based follow-up protocol of telepsychiatry that seeks to improve continuity of psychiatric care through organized reminders, organized nursing follow-ups, and standardized approaches to engaging with patients. The project is informed by the following PICOT question: In an outpatient telepsychiatry clinic nursing staff: How a standardized-telepsychiatry follow-up protocol (as suggested by the CPSTF), in the use of a reminder system, versus current practices affect the level of follow-up compliance over a 12-week period? The intervention process will involve providing the automated text messages, and this will be provided via a simple practice electronic health record system, followed by the process of communication via the telephone to the nursing staff and standardisation of the documentation process to enhance continuity and communication. The practice gaps that were identified in the clinic and will be supported by the intervention are the absence of regular follow-up practice, the adoption of standardized attendance of the patients during the scheduled telepsychiatry sessions, and the absence of standardized reminders.

This Baseline data of the practicum site showed that 25 percent of the patients visited the clinic during the 30 days follow up, which is significantly low compared to the national standard on psychiatric follow-up visits (Clinical Director, personal communication, November 3, 2025). The researchers Chen et al. (2022) prove that well-structured reminder systems and interventions with the help of telepsychiatry may increase the attendance rates, positive engagement with patients, and reduce the number of no-shows in psychiatric groups. The plan-do-study-act (PDSA) model is also utilized in the project to support the implementation process that requires continuous evaluation, testing, and improvement to achieve this. The expected outcome of the intervention is that patient compliance rates with follow-ups should be at least 20% higher in 12 weeks, leading to better continuity of psychiatric care, better symptom management, and risk of relapse and emergency psychiatricity.

Slide 4

Project Implementation

The implementation of the telepsychiatry follow-up improvement initiative will be implemented in a 12-week PDSA process that will assist in structuring the implementation, monitoring, and evaluation of the intervention. The nursing employees will go through a learning and training session in Week 134 on issues of the standardized telepsychiatry follow-up guidelines, reminder-system guidelines, documentation guidelines, and patient-engagement guidelines. Training will include a demonstration of how to use the simple practice electronic health record system to send out automated text messages as reminders, documentation of reminders, and making outreach telephone follow-up calls. The intervention will be implemented during the weekly clinical practice, Weeks 4-11. The standardized protocol will be implemented by nurses who will send automatic notifications to patients 72 hours prior to appointments and make phone calls 24 hours prior to scheduled telepsychiatry appointments (Simple Practice electronic health record dataset, internal site, November 03, 2025). All the outreach and follow-ups to the patients will be logged in the electronic health record system to help in continuity and tracking of care. They will be measured and held accountable in a weekly meeting with the stakeholders during the implementation process to identify obstacles, assess the workflow functionality, and provide ongoing support to the employees. The project evaluation and analysis of the results in Week 12 will be achieved with the help of the electronic health record audit, rate of adherence, percentage of no-show, and documentation completion rate of the reminders. The above research has revealed that a structured reminder system and telepsychiatry after-follow-up interventions can be effective in improving the attendance rate and reducing the rate of missed psychiatric appointments (Chen et al., 2022). Week 4 and Week 8 evaluations will help determine the nursing staff engagement, pattern of patient interaction, and compliance with protocol, and the progress toward the achievement of at least a 20% increase in the follow-up adherence rates.

Slide 5

Barriers

The effective application of the standardized telepsychiatry follow-up protocol can be influenced by a number of barriers that can be encountered in routine clinical practice. It may be difficult to ensure regular backup reminder outreach and follow-ups, handle high patient volumes, schedule tasks, documenting work, among other clinical tasks (Berardinelli et al., 2024). The time of making patient contacts through the phone, recording contacts with patients, and monitoring the trends of attending appointments can be minimized by working loads and opposing duties. The lack of consistency in integrating the workflow can also be the cause of different results of protocol adherence and quality of communication among the personnel. Delays in documenting eHRS, being unaware of how a reminder system works, and disturbances in workflow concerning the telepsychiatry scheduling are some of the other problems to consider (Alzghaibi and Hutchings, 2024). The inability to be comfortable on digital platforms and electronic communication systems can decrease productivity during outreach initiation to patients and the ability to input data in a timely manner in the simple practice electronic health record system. Barriers related to patients can be missed phone calls, out-of-date contact data, decreased involvement in telepsychiatry services, and uneven responsiveness to automated notifications. The authors discovered that the implementation strategies that will respond to the implementation difficulties will be regular staff support, working schedules, flexible scheduling methods, regular stakeholder communication, standard documentation practices reinforcement, use of automated reminding mechanisms, and telehealth services to increase patient engagement and adherence (Adeniyi et al., 2024).

Slide 6

Project Strengths

The telepsychiatry follow-up improvement project has several strengths that can facilitate its success and sustainability in the long-run. The use of an evidence-based intervention using recommendations of the community preventive services task force and current literature relates to the telepsychiatry reminders system and psychiatric follow-up compliance is a strength. Organized reminder and nursing follow-up activities aid in the organization of continuity of psychiatric care. Integration of remote (telehealth) staff, administrative, and leadership teams improves communication, workflow coordination, and implementation, as well as patient involvement in outpatient psychiatric health care.

Another strength of the simple practice electronic health record system is the reminder and documentation processes, since it has already integrated them. Adeniyi et al. (2024) highlight that the system enables monitoring compliance on follow-up, documenting outreach efforts, patient outreach, and automating booking of appointments before telepsychiatry. Engagement of nursing staff in reminder outreach and contacting the patients would boost the therapeutic relations and encourage them to proceed with more psychiatric treatment. To conclude, Berdardinelli et al. (2024) discovered that patients with a more effective continuity of care and greater levels of adherence to appointment attendance experienced improved follow-up communication with the nurse when it was structured. Frequently reviewing the outcomes, the quality of the working process, and the extent to which the implementation is improving in every project phase can also be facilitated with the PDSA model because it helps to evaluate the process and improve it constantly.

Slide 7

Project Weaknesses

The telepsychiatry follow-up improvement initiative has several limitations that could potentially impact the implementation process when evaluating the initiative. Implementation time (12 weeks) might not be sufficient to determine the sustainability of higher follow-up adherence rates or to determine whether the patient engagement is not going to alter after a longer period of time. Maoz et al. (2024) wrote that continuity of psychiatric care involves continuous involvement and protracted behavioral involvement; thus, temporary changes in appointment attendance might not be fully manifested in enduring practices and patient involvement. The small sample size and the one outpatient psychiatric clinic that has only two psychiatric nurse specialists are the other limitations, as they are involved in the implementation of the protocol. A small sample might result in fewer extrapolations of the findings to other big psychiatric hospitals or other healthcare settings. Brancewicz et al. (2025) point out that even patterns of patient participation may vary during the implementation due to the absence of appointments, changes of contacts, or disproportionate response to outreach through reminders or varying levels of interest in the services of telepsychiatry. Other limitations could be connected with the use of electronic health records and reports on workflow by staff members at the time of data collection and assessment. The lack of documentation, slow charting, and failure to document the reminder may affect the quality of follow-up adherence data and the measure of protocol faithfulness. However, despite these challenges, standardized telepsychiatry follow-up practices that are founded on formalized reminder systems are still pushing towards an improved continuity of care support, patient engagement, and evidence-based practices within an outpatient mental health care setting.

Slide 8

Project Opportunities

Significant opportunities to contribute to the continuity of psychiatric care and improve the evidence-based practice exist, and the telepsychiatry follow-up improvement project can be adopted. Principled admonition strategies and formal nursing follow-up strategies may be prolonged to incorporate additional outpatient behavioral health and tailored to other psychiatric groups that require long-term follow-up assistance. According to Hu et al. (2025), automated texts, secure portal messaging, virtual visits, and coordinated remote follow-up services can be useful in enhancing patient engagement in telepsychiatry with the integration of digital health tools. Digital communication tools could be used to improve psychiatric services, the number of patients visiting the appointments could be increased, and the unavailability of behavioral healthcare services would be reduced, depending on the transportation, scheduling issues, and challenges of accessing the psychiatric service. Effective implementation of standardized reminder and follow-up working process is able to lead organizational policies in the future concerning telepsychiatry organization and outreach to patients in the outpatient psychiatric setting. Long-term follow-up systems would continue to be used, might serve to improve continuity of care, patient outcomes, decrease preventable crises and ED use, and encourage value-based care.

Slide 9

Project Threats

Follow-up improvement initiative on tele psychiatry has a number of external risks to long-term sustainability. Nurse attrition in an outpatient psychiatric clinic can lead to inconsistency in the adoption of the standardized follow-up guideline, as well as a decrease in continuity in the communications procedures based on reminders. Competing clinical needs and workload pressures, which may limit consistency of follow-up, particularly with structured follow-ups, in the long term, can also be problematic in this case. The lack of funds or other organizational resources, or the inability to offer the staff constant support and training, could be the reasons that restrict the need to employ automated reminder systems. Ebo et al. (2025) state that alterations in organization policies or priorities can also have a greater impact on integrating telepsychiatry follow-up processes in regular clinical workflow. The constraints of the simple practice electronic health record system can be technical issues and differences in staff skills in using digital health tools, which might lead to issues with timely documentation and the effective use of reminders. The risks can be reduced with the help of the following strategies: further education of the staff, workflow integration, resource allocation, support to the leaders, and constant training of the staff to make them more digitally competent professionals in nursing. To increase the sustainability of the long-term and increase the predictability of patient engagement and inclusion of the conventional follow-up protocol in routine clinical practice can also be employed.

Slide 10

Expected Outcomes

The expected results of the telepsychiatry follow-up improvement program will consist of clinical patient engagement improvements, as well as quantifiable improvements in the care delivery processes. The ultimate outcome will be to establish the patient follow-up adherence rates high in the outpatient telepsychiatry clinic and to increase the immediate follow-up rate by 25 percent and establish it at least 20 percent higher. The compliance will probably be enhanced, and the sustainability of psychiatric treatment, prompt clinical follow-ups, and minimization of recurrence and emergency psychiatric consumption in adults with a chronic mental issue will be achieved. The reduction of the no-show rates (20-30 percent), improved attendance in appointments, and enhanced use of automated and nurse-led reminder systems are the secondary outcomes. Other process outcomes will include better accuracy and completeness of documenting the electronic health records, increased adherence to standardized reminders among nursing staff, and increased involvement of patients using telepsychiatry services. As shown by Brancewicz et al. (2025), the intervention and reminder systems, which were planned and based on telecommunications, positively affected the adherence to psychiatric appointments and continuity of care. It is assumed that the project will help to make nursing workflow more efficient, improve staff coordination, and possibly introduce a sustainable, standardized system of telepsychiatry follow-up that can be implemented in other outpatient mental health care centers.

Slide 11

Conclusion

Continuity of psychiatric follow-up and involvement of the patients in the outpatient clinic are being enhanced by the follow-up improvement program of telepsychiatry. Its implementation is up-to-date and based on the 12-week PDSA model, with some initial positive workflow changes and an increase in the compliance levels of the staff with the reminders. There are some small problems, but no significant disturbance to the progress. Application of the PDSA cycle will be used in ensuring a continuous improvement and strengthening the evidence-based psychiatric care and patient-based outcome over the long run.

References

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Alzghaibi, H., & Hutchings, H. A. (2024). The impact of leadership and management on the implementation of electronic health record systems in the primary healthcare centers. Healthcare, 12(20), 20-23. https://doi.org/10.3390/healthcare12202013

Berardinelli, D., Conti, A., Hasnaoui, A., Casabona, E., Martin, B., Campagna, S., & Dimonte, V. (2024). Nurse-led interventions for improving medication adherence in chronic diseases: A systematic review. Healthcare, 12(23), 2337–2340. https://doi.org/10.3390/healthcare12232337

Brancewicz, M., Robakowska, M., Śliwiński, M., & Rystwej, D. (2025). SMS and telephone communication as tools to reduce missed medical appointments. Applied Sciences, 15(17), e977789 https://doi.org/10.3390/app15179773

Chen, M., Zhou, L., Ye, L., Lin, G., Pang, Y., Lu, L., & Wang, X. (2022). Initial adherence by psychiatric outpatients in a general hospital and relevant personal factors. BioMed Central Psychiatry, 22(1), 137-138. https://doi.org/10.1186/s12888-022-03797-3

Ebo, T. O., Olawade, A. C. D., Ebo, D. M., Egbon, E., & Olawade, D. B. (2025). Transforming healthcare delivery: A comprehensive review of digital integration, challenges, and best practices in integrated care systems. Digital Engineering, 6(6), e100056. https://doi.org/10.1016/j.dte.2025.100056

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