Extending the reach of inpatient consultation-liaison psychiatry: A systematic review of telepsychiatry in U.S. general hospitals.

BACKGROUND

Psychiatrist shortages and rural hospital gaps limit inpatient consultation-liaison (C-L) psychiatry in U.S. general hospitals. Telepsychiatry has expanded rapidly, yet implementation models, outcomes, and challenges of inpatient C-L telepsychiatry remain incompletely and inconsistently described.

METHODS

We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched major medical, nursing, and psychological databases and ClinicalTrials.gov (1990-November 2025) for English-language studies of adult inpatient C-L telepsychiatry in U.S. general hospitals. Two reviewers independently screened, extracted data, and appraised quality with Joanna Briggs Institute tools.

RESULTS

Seventeen studies met inclusion criteria with no randomized or quasi-experimental trials. Most programs used hub-and-spoke models linking community hospitals with academic C-L services, supported by local staff for technology and workflow. Consults commonly addressed mood and substance use disorders, delirium or other neurocognitive syndromes, and capacity, and often led to medication changes. Operational outcomes suggested improved access and shorter time-to-consult, while some requests were triaged to in-person care when clinical or technical factors limited virtual assessment. Clinicians generally viewed inpatient telepsychiatry as feasible but described difficulty assessing delirium and agitation and limited interpreter integration; patient-centered outcomes, cost, and equity measures were rarely reported.

CONCLUSIONS

Inpatient C-L telepsychiatry appears feasible across diverse U.S. hospitals and can extend psychiatric expertise to underserved settings while preserving key liaison functions when supported by clear triage pathways, in-person backstops, and coordination. However, evidence is largely observational; rigorous multi-site comparative studies with standardized clinical, operational, cost, and equity outcomes are needed.