Table 2:

Observation Guide

Field Observations: Goal is to describe what you see/hear using thick description. You do not need to answer all questions.
Research Questions:	To observe team dynamics, making note of what works well and what can be improved in the hand-off process • To identify barriers to sustainment of tele-mental health care in ED/UC (Maintenance) • To identify unique facilitators that may not replicate to other facilities (Implementation & Maintenance)
Who is the ED/UC provider? Who is the on-site Mental Health Officer of the Day (MHOD)?(Adoption) Who is remote MHOD?(Adoption) Who is the veteran? (what are their demographics? What is the presenting problem?) (Reach)
Context: Social surroundings and recent events affecting the interaction.
Where is the TMH visit taking place (ED/UC? Private room? Description of the room e.g. clear walls, etc.)? (Implementation) Describe the ED/UC. (How busy is it? How frantic or stressed do staff seem?) (Implementation) Where there any other relatives or friends of patient present? If yes, Describe. What was the role of the observer? (do they introduce themselves?)
Content: What happens during the observation. Guided by the research question.
Describe the process of identifying the Veteran for TMH. (What was exchange amongst providers? Were there any concerns voiced regarding appropriateness?) (Reach) Describe the process of alerting the Remote MHOD. Capture communication and verbal exchanges (if possible). Any delays from ED/UC provider or local MHOD? (Implementation) Describe the process of handoff from ED/UC attending to remote MHOD. Capture communication and verbal exchange (if possible). Was there difficulty or delay connecting the two? (Implementation) Who is assigned to the case? (Nurse or Tech?) Describe demeanor of nurse/tech (Busy? Friendly? Relaxed? Confident? Distracted?) (Adoption) How does the setup for the Veteran occur? Any issues with equipment (e.g. is it charged)? Any delay in nurse/tech reaching MHOD? How is the patient introduced to remote MHOD? (Implementation) Describe demeanor of the Veteran during the encounter (e.g. relaxed, engaged, agitated, annoyed?) (Reach) Were there any notable “workarounds” or trouble shooting solutions to resolve issues? (Implementation) Did any technical issues arise during consultation? Did the Veteran need or appear to need local assistance? Did the MHOD contact local staff during consultation? (Implementation) If possible, describe the handoff between Remote MHOD and ED/UC attending. Any delays or difficulty connecting the two? (Implementation)
Concepts: Connects the field observations with the research question and/or theory.
What are the overarching themes you’ve noticed? General ideas/themes around the environment or space.

Note: ED = emergency department, UC = urgent care center, MHOD = mental health officer of the day. RE-AIM outcomes indicated in parentheses.