“Partners in Behavioral Health Emergency Services”
Achieving Tomorrow, Today
DMH and the South Carolina Hospital Association (SCHA) requested assistance from The Duke Endowment (TDE) to develop a statewide telepsychiatry network for all SC hospitals operating emergency departments (EDs) and received the first grant on November 30, 2007. To date, the program has received more than $7.25 million to this end.
The continuing objective of the program is to make psychiatric consultation available in all SC EDs at any hour. The consultations have increased the quality and timeliness of triage, assessment and initial treatment of patients; reduced the number of individuals and length of stay in EDs; and allowed hospitals to direct critical personnel and financial resources to other needs; thus, realizing financial savings for hospitals.
Goals and Objectives:
Increase the number of patients receiving comprehensive assessment utilizing telemedicine technology.
From 2010 to 2012, the average number of behavioral health patients receiving telepsychiatric consultations increased from 8.7 to 11.6 per day.
Ensure focused documentation is generated for each telemedicine consultation.
Through the use of a comprehensive electronic medical record (EMR), assessments and hospital notes can be referenced for treatment, discharge planning and billing purposes.
Maximize the number of patients seen through a seamless joint consultation process.
Pre-telepsychiatry service delivery relied on a mental health professional (MHP) traveling to the local ED – now, with recommendations being given to ED physicians within a much shorter period of time, medications, discharge planning and follow-up can decrease the recovery time of behavioral health patients.
Secure better quantitative information on the diagnosis of MH, substance abuse, and co-occurring disorders.
For example: at the end of December 2012, behavioral health patients presenting to the ED and receiving consultations via telepsychiatry, had the following…
Primary diagnoses: 35% mood disorder, 33% psychosis and 18% drug related. Additional diagnoses (e.g. secondary, tertiary), 54% were drug related (reflecting a significant co-occurring trend not seen to this degree in the outpatient mental health system), 12% anxiety and 11% mood related.
Reduce the average length of stay (LOS) in the ED.
Considering instances when a behavioral health patient presents to the ED over the weekend – LOS in situations where telepsychiatry was either not available or requested, the behavioral health patient could experience a stay of two to three days (48-72 hours) before being assessed by a MHP. For the month of December 2012, that wait time had drastically decreased to six hours on average.
Increase the number of professional staff in local hospitals receiving training via the DMH training presentations.
The Palmetto State Provider's Network (PSPN) has developed subscription-based access to a statewide fiber optic network and hospitals all across South Carolina are realizing the potential impact of both clinical and technical training for their employees through electronic means. At the end of December 2012, 16 of 20 participating hospitals were connected to the PSPN network.
Increase the number of psychiatrists and psychiatric residents trained to use the telemedicine system and provide opportunity for a larger pool of psychiatrists for consultation.
Recruiting for and the training of telepsychiatrists in South Carolina is scheduled to begin February 1, 2013.
Reduce the cost of mental health care by decreasing the utilization of sheriff deputies, probate judges, and designated examiners.
Given the decrease in wait times for receiving consultative services, the timely administration of medications and effective referrals of the behavioral health patients to other local agencies as well as the DMH outpatient clinic system, the use of deputies, judges and examiners becomes less and less frequent.
DMH, as lead agency, will continue to oversee the program.
SCHA, a private, not-for-profit organization comprised of 130 institutions and 900 associated members, is developing a uniformed credentialing application to be first used for our telepsychiatrists.
SC Department of Health and Human Services (HHS), the state’s Medicaid agency, will partner to development a statewide medical health record and increase IT infrastructure.
The Duke Endowment (TDE) is committed to funding innovative healthcare programs designed to raise the quality of healthcare and develop lasting community infrastructure for future growth.
University of South Carolina (USC) School of Medicine Department of Neuropsychiatry and Behavioral Science continues to offer advice and expertise as the program develops; and USC recently was awarded an R01 grant to aggregate the community based financial data from the program.
Department of Psychiatry of the Medical University of South Carolina (MUSC) has also pledged to offer advice and expertise and in providing clinical office space for telepsychiatrists.
South Carolina Budget & Control Board’s Office of Research & Statistics (ORS) is the primary technical lead responsible for the development of an electronic health record (EHR) through an interface called SCHIEx (South Carolina Health Information Exchange).
Department of Psychiatry and Health Behavior at the Medical College of Georgia (MCG) agreed to share lessons learned from its successful cardiac telemedicine project.