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Technology delivers help faster to mentally ill patients in ERs
Program cuts hospital stays for mentally ill, reduces costs

By Liv Osby • Staff Writer • June 28, 2010

Jennifer Scruggs, a Baptist Easley Hospital emergency room nurse, demonstrates a mobile telepsychiatry cart in an exam room.  (HEIDI HEILBRUNN/Staff)

Baptist Easley, the first hospital to join a state program to use long-distance technology to treat mentally ill patients admitted to its emergency room, has already seen tangible benefits, says Dr. Scott Parker, medical director for the hospital.

“Since we began using telepsychiatry, we have seen our consultation waiting period go from days per patient to hours,” he said.

The new technology not only gets those patients treated in a fraction of the time, it reduces the need for psychiatric hospitalization and saves money, too.

Telepsychiatry links a patient with a psychiatrist for a remote consultation via a secure interactive system that uses high-definition television screens.

The South Carolina Department of Mental Health has been piloting the system at 16 hospitals around the state with more than 2,700 consultations performed so far.

“Mental health resources are scarce in South Carolina, especially in smaller and rural counties, so for years, we domiciled the patient in the emergency department, sometimes up to a week or more, a guard posted outside, (waiting for) an evaluation,” said Parker “It was not a pleasant circumstance for anybody — patients, families or staff.”

But DMH now has four psychiatrists, who are as legally responsible as if they’d been in the ER themselves, providing consultations 16 hours a day seven days a week, said Dr. Brenda Ratliff, the program’s medical director,

“It’s a way to get around the shortage of psychiatrists,” she said.

And it’s a way to stretch budgets hammered by years of budget cuts.

Patients may arrive in the ER with problems ranging from depression and hallucinations to suicidal thoughts and psychotic behavior, she said.

Before the hourlong consultation, the psychiatrist reviews the patient’s medical record electronically and then, after a comprehensive evaluation, recommends commitment or a treatment plan for those who can be discharged, she said.  Medication if often recommended, too, along with any support the patient might need, such as shelter, transportation or legal counsel, she said.

Sometimes, a patient who is waiting for a hospital bed is stabilized enough after the first consultation that hospitalization is no longer needed, Ratliff said.

“Our goal is to reduce the number of patients waiting in ERs that back up,” said Ratliff.  “And the number waiting and length of stay has decreased.”

Statewide, the average length of stay for a psychiatric patient in a hospital ER is six to eight days at $500 to $700 a day, said Ed Spencer, director of the telepsychiatry program for DMH.  And at Springs Memorial, a 231-bed hospital in Lancaster, the program has saved more than $200,000 and cut that stay from 3.8 days to about seven hours in the first eight months, he said.

Surveys of patients reveal that nine of 10 were comfortable with telemedicine, satisfied with the experience and would use it again, Spencer said.

For most patients, telepsychiatry is a blessing, says Kelly Troyer, executive director of the Greenville chapter of the National Alliance on Mental Illness.

“There aren’t enough doctors, and there aren’t enough hospital beds, so any way that a person who is in need of care can get treatment more readily is great,” she said.  “There is less trauma for the patient, and they get immediate treatment instead of that holding cell situation we were in before, and I’m all for that.”

Surveys also show the program improves staff morale because patients get the care they need, and it’s easier to care for them because they are less agitated and demanding, Ratliff said.

More than 96 percent of nurses and other staff surveyed said telepsychiatry allowed them to use their time more efficiently and improved patient care, Spencer said.  And 100 percent of doctors said they were satisfied with the treatment recommendations while 92.3 percent said the consult made them more comfortable assessing patients.

The program has been funded by the Duke Endowment, which recently gave DMH another $2.5 million to expand to other hospitals.  The equipment costs about $55,000, and participating hospitals pay a third of that with the grant picking up the rest, Ratliff said.

The department bills patients’ insurers, Medicare or Medicaid for the service, she said.  But those who cannot pay — about half of all patients — are seen anyway, she said.

And because psychiatric patients are spending less time in the ER, patients there for physical ailments are seen faster too, he said.  Enough bed space was freed up in the ER to see an additional 275 patients a year, Parker said.

There’s still a wait for patients who need to be committed because a limited number of psychiatric beds are available.  But the number of patients who need to be committed has been reduced because of the timely treatment they’re getting now, he said.

Because telepsychiatry has been so successful, Baptist Easley began teleneurology for stroke patients and is looking to expand the technology to other specialties as well, including dermatology and infectious diseases, Parker said.

Troyer says telepsychiatry is a step in the right direction in terms of society’s treatment of the mentally ill.

“It saves money, and it’s more humane,” she said.  “It’s a win for the consumer and a win for the community.”