Case study · Outpatient psychiatry, critical access hospital
Mountrail County Medical Center got its patients back.
A critical access hospital in Stanley, North Dakota, added a telehealth psychiatric nurse practitioner and recovered patients it had been sending an hour away. Demand outpaced capacity within weeks.
Before
The problem they came with
Mountrail County Medical Center in Stanley, North Dakota, provides emergency and primary care, along with clinical and social services, to a community of more than 15,000 residents. Open since the 1940s, it remains rooted in the mission of providing quality health services to Mountrail County and the surrounding area.
It had no dedicated behavioral health provider. Patients with depression, anxiety or suicidal thoughts were routinely referred to other health systems, some more than an hour away, and waited days or weeks to be seen. Visiting providers came, but rarely. In the meantime the medical center’s own clinicians did what they could, which often meant trialing medications to see what helped.
A lot of our cases before [PMC] were usually referred out. We didn’t have much locally, aside from some visiting providers who would come here, but they were far and few between.
The decision
A consistent provider, rather than an occasional one
The alternative on the table was what they already had: visiting providers, far and few between.
Recruiting a psychiatric provider to a town of Stanley’s size was not a realistic option. Visiting providers came occasionally, but occasional had never added up to a service. What the medical center needed was one clinician its patients and staff would see every week, someone who could assess, counsel, and manage medication, and whose hours could expand if demand warranted it.
A telehealth psychiatric nurse practitioner met all of that. The commitment started small, two days a week, with the option to add days as the calendar filled.
The program
What went live, and when
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A partnership launched
Mountrail County Medical Center partners with PMC for a psychiatric provider who can assess and counsel patients by telehealth and manage medication.
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Two days a week
PMC’s provider, Rosalyn Geier, a board-certified psychiatric nurse practitioner, begins seeing patients two days a week.
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Slots fill, expand to three days
Appointments fill quickly. The medical center expands the service to three days a week.
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Patients come home
Patients who had been receiving care in other counties switch back to the medical center, especially through the winter travel season.
Staff work alongside the provider week to week; patients, Wollesen says, enjoy her “bubbly personality” and kindness, which is its own kind of continuity in a small town.
Results
What changed for the community
Access
- 3
- provider days a week, up from two, expanded when slots filled
- 1
- dedicated behavioral health provider, where there had been none
- 1 h+
- of driving no longer required for local patients
Winter travel is the test in Mountrail County. Patients who used to drive an hour or more to another county for care now stay local, and many who had left have switched back.
Now that we have a behavioral health provider, we’ve had a lot of patients switch back to us. It’s been really good having [PMC] here.
Transferable
What this looks like for your facility
If your hospital is referring behavioral health patients outside your community, PMC can help you evaluate whether a scheduled telehealth model could work for your patient population.
Mountrail started with two days of coverage per week and expanded to three as demand grew, without recruiting a full-time provider or building new infrastructure.
