South Carolina Department of Mental Health (DMH)South Carolina Department of Mental Health (DMH)Division of Medical AffairsDivision of Medical Affairs

Telepsychiatry Consultation Telepsychiatry Consultation ProgramProgram

Achieving Tomorrow, TodayAchieving Tomorrow, TodayLast Update: 03/31/2014Last Update: 03/31/2014 11

Trends In Healthcare:Trends In Healthcare:Telemedicine Use in Emergency Telemedicine Use in Emergency

Departments, Departments, A Behavioral Health SolutionA Behavioral Health Solution

Last Update: 04/18/2013Last Update: 04/18/2013 22

OverviewOverview the Problems – the Problems – Patient Back-up in the Patient Back-up in the

Emergency Department (ED)Emergency Department (ED) the Partnerships –the Partnerships –

The Duke Endowment, SC Department of The Duke Endowment, SC Department of Health and Human Services, SC Health and Human Services, SC Department of Mental Health, and the SC Department of Mental Health, and the SC Hospital AssociationHospital Association

the Proposal – the Proposal – an initial Three-year Grantan initial Three-year Grant the Purpose – the Purpose – Achieving Tomorrow, TodayAchieving Tomorrow, Today

Last Update: 12/07/2012Last Update: 12/07/2012 33

Primary GoalsPrimary Goals

Timely Psychiatric Assessment and Timely Psychiatric Assessment and Rapid Initiation of TreatmentRapid Initiation of Treatment

Increased Quality of CareIncreased Quality of Care Reduced Lengths of Stay (LOS)Reduced Lengths of Stay (LOS) Comprehensive Discharge PlanningComprehensive Discharge Planning Savings to the Hospital and Savings to the Hospital and

CommunityCommunity

Last Update: 08/25/2014Last Update: 08/25/2014 44

Remote Site LocationsRemote Site Locations

Last Update: 08/25/2014Last Update: 08/25/2014 55

Clinical Office LocationsClinical Office Locations

Columbia, SC (2)

Aiken, SC (2)

Charleston, SC (2)

Anderson, SC

Conway, SC *

Spartanburg, SC *

* FUTURE

Last Update: 04/18/2013Last Update: 04/18/2013 66

Consultation ProcessConsultation Process

Patient Presents in EDPatient Presents in ED ED Physician Requests ConsultED Physician Requests Consult Psychiatrist Reviews CIS/SCHIEx, EMRPsychiatrist Reviews CIS/SCHIEx, EMR Patient ConsultedPatient Consulted Video Encounter EndsVideo Encounter Ends Psychiatrist Electronically Signs Psychiatrist Electronically Signs

ConsultConsult Recommendations Sent to EDRecommendations Sent to ED Hospital Dispositions the PatientHospital Dispositions the Patient

Last Update: 08/25/2014Last Update: 08/25/2014 77

Dashboard - TimeDashboard - Time

Current program results: 42% Current program results: 42% recommended for discharge the same recommended for discharge the same day (24-48 hours) of consultationday (24-48 hours) of consultation

Comparing end of first quarter CY Comparing end of first quarter CY 2009 (pre-Telepsychiatry) to end of 2009 (pre-Telepsychiatry) to end of CY 2013 (Telepsychiatry) for Mental CY 2013 (Telepsychiatry) for Mental Health Patients in SC ED’s…Health Patients in SC ED’s… Overall Patient Wait Times for Inpatient Overall Patient Wait Times for Inpatient

Admissions were down by 46%Admissions were down by 46%

Last Update: 08/25/2014Last Update: 08/25/2014 88

Turn-AroundTurn-Around

10.6 hours from initial ED request for 10.6 hours from initial ED request for Telepsychiatry to transmission of patient Telepsychiatry to transmission of patient recommendations (CY 2014 to date)recommendations (CY 2014 to date) Compared to 2-4 days, pre-TelepsychiatryCompared to 2-4 days, pre-Telepsychiatry

10.6 consults every 16 hour day (CY 10.6 consults every 16 hour day (CY 2014 to date)2014 to date) Compared to 1-4 consultations by local MHC Compared to 1-4 consultations by local MHC

MHP’s (post-weekend) during a 8 hour dayMHP’s (post-weekend) during a 8 hour day

Last Update: 02/03/2014Last Update: 02/03/2014 99

Satisfaction SurveysSatisfaction Surveys

Survey Results – PatientsSurvey Results – Patients

Positive Impact on Patients… Positive Impact on Patients… 90.7% of ED Staff state Telepsychiatry is 90.7% of ED Staff state Telepsychiatry is

an efficient use of Patient’s time; an efficient use of Patient’s time; 95.3% of ED Staff state Patients appear 95.3% of ED Staff state Patients appear

comfortable during consultations; and, comfortable during consultations; and, 95.4% of ED Staff state Patients are 95.4% of ED Staff state Patients are

cooperative during the consultation cooperative during the consultation

Last Update: 03/2014Last Update: 03/2014 1010

Survey Results - EDsSurvey Results - EDs

Benefits to the Emergency Departments… Benefits to the Emergency Departments… 83.4% of ED Physicians state Telepsychiatry is 83.4% of ED Physicians state Telepsychiatry is

an efficient use of ED Staff’s time; an efficient use of ED Staff’s time; 100% of ED Physicians state they are satisfied 100% of ED Physicians state they are satisfied

with the availability of Telepsychiatry; with the availability of Telepsychiatry; 100% of ED Physicians state they are satisfied 100% of ED Physicians state they are satisfied

with the thoroughness of consults; and, with the thoroughness of consults; and, 83.3% of ED Physicians state they are satisfied 83.3% of ED Physicians state they are satisfied

with disposition recommendations with disposition recommendations

Last Update: 03/2014Last Update: 03/2014 1111

Survey Results - Survey Results - AdministrationAdministration

Efficient Use of Hospital Resources…Efficient Use of Hospital Resources… 94.4% of Hospital Administrators state 94.4% of Hospital Administrators state

the program is an efficient use of the program is an efficient use of hospital funds; hospital funds;

94.4% of Hospital Administrators would 94.4% of Hospital Administrators would recommend the program to other recommend the program to other HospitalsHospitals

Last Update: 03/2014Last Update: 03/2014 1212

Last Update: 08/25/2014Last Update: 08/25/2014 1313

R01 Grant ResearchR01 Grant Research Collateral Effect: Reallocation of Collateral Effect: Reallocation of

Resources by ED’s to ED-appropriate Resources by ED’s to ED-appropriate carecare

Reduced Commitment Rate to BH Reduced Commitment Rate to BH Inpatient BedsInpatient Beds

Reduction in Average Inpatient LOSReduction in Average Inpatient LOS Produced Savings of $1,400 in BH Produced Savings of $1,400 in BH

Inpatient Settings per Care EpisodeInpatient Settings per Care Episode Equals (approx.) $28.4 M in BH Equals (approx.) $28.4 M in BH

Inpatient SavingsInpatient Savings

Last Update: 04/18/2013Last Update: 04/18/2013 1414

WebsiteWebsite

Last Update: 09/16/2013Last Update: 09/16/2013 1515

For more information, please visit: For more information, please visit:

www.scdmh.org/telepsychiatrwww.scdmh.org/telepsychiatryy

or contact our program office: or contact our program office:

Ed Spencer, M.Ed. MSW, Ed Spencer, M.Ed. MSW, Program DirectorProgram Director(803) 898-8579(803) 898-8579

Ralph Strickland, CoordinatorRalph Strickland, Coordinatorrns42@scdmh.orgrns42@scdmh.org