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TeleHealth & Broadband ConferenceTeleHealth & Broadband ConferenceOctober 19, 2012October 19, 2012

Prattville, AlabamaPrattville, Alabama

A Story of Clinical Success:A Story of Clinical Success:the DMH Telepsychiatry the DMH Telepsychiatry

Consultation ProgramConsultation Program


OverviewOverview the Problems – the Problems – Timeliness and Hospital Timeliness and Hospital

Emergency Department (ED) Behavioral Health Emergency Department (ED) Behavioral Health (BH) Costs(BH) Costs

the Partnershipsthe Partnerships The Duke Endowment, SC Department of The Duke Endowment, SC Department of

Health and Human Services, SC Department Health and Human Services, SC Department of Mental Health, and the SC Hospital of Mental Health, and the SC Hospital AssociationAssociation

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


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


Partnership Partnership DiagramDiagram

BaptistEasley

Conway

McLeodSeacoast

Chester

McLeodDillon

RoperBerkeley

Carolinas CarolinasMarion

GrandStrand

Clarendon

Fairfield

George-town

HamptonWacca-maw tRMC McLeod

LorisSprings

SC DHHS

Laurens

WallaceThomson

UpstateCarolina

Upstate

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Remote Site LocationsRemote Site Locations


Clinical Office LocationsClinical Office Locations

Columbia, SC

Aiken, SC

Charleston, SC(2)

Conway, SC


Consultation ProcessConsultation Process Patient Presents in EDPatient Presents in ED ED Physician Requests ConsultED Physician Requests Consult Psychiatrist Reviews CIS/SCHIExPsychiatrist Reviews CIS/SCHIEx Patient ConsultedPatient Consulted Encounter EndsEncounter Ends Psychiatrist Electronically Signs ConsultPsychiatrist Electronically Signs Consult Recommendations Sent to EDRecommendations Sent to ED Hospital Dispositions the PatientHospital Dispositions the Patient


Consults & Patients Kept Consults & Patients Kept (2012)(2012)


Clinical OperationsClinical Operations


DiagnosesDiagnoses


Dashboard - TimeDashboard - Time Current program impact results in a Current program impact results in a

44% discharge rate for same day of 44% discharge rate for same day of consult for those seenconsult for those seen

Even with a 40% increase in BH Even with a 40% increase in BH patients presenting in ED’s, patients presenting in ED’s, “Snapshot Average Wait Times” “Snapshot Average Wait Times” (09/2009 v. 09/2012) have not (09/2009 v. 09/2012) have not significantly increased (~2%)significantly increased (~2%)


Turn-AroundTurn-Around 6.25 hours from initial ED request for 6.25 hours from initial ED request for

Telepsychiatry to patient discharge Telepsychiatry to patient discharge (10/2012)(10/2012)

11.9 consults every 18 hour day 11.9 consults every 18 hour day (09/2012)(09/2012)


Data ResourcesData Resources CIS – DMH patients (past/present) *CIS – DMH patients (past/present) * EMR – DMH Intranet-based medical EMR – DMH Intranet-based medical

assessment formassessment form SCHIEx – ORS repository for multi-SCHIEx – ORS repository for multi-

agency database downloads *agency database downloads *

* 75-80% ED patients known across both databases


SC UCAPSC UCAP


Palmetto State Providers Palmetto State Providers NetworkNetwork


Satisfaction SurveysSatisfaction Surveys


Survey Results - PhysicianSurvey Results - Physician


Survey Results - PatientSurvey Results - Patient


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 $1,800 in BH Produced Savings of $1,800 in BH

Inpatient Settings per Care EpisodeInpatient Settings per Care Episode Equals (approx) $23 M in BH Inpatient Equals (approx) $23 M in BH Inpatient

SavingsSavings


Sustainability – RevenuesSustainability – RevenuesFY 13

36%

27%

25%

12%

TDE SC DHHSSC DMH Hospitals

PRIOR YEARS

100%

TDE


WebsiteWebsite


For more information, please For more information, please go to our website: go to our website:

http://www.scdmh.org/telepsychiatry

or contact our program or contact our program office: office: Ed Spencer, Program DirectorEd Spencer, Program Director

(803) 898-8579(803) 898-8579Ralph Strickland, CoordinatorRalph Strickland, Coordinator

[email protected]

http://www.scdmh.org/telepsychiatry

mailto:[email protected]

ed spencer file ppt int dmh affairs telepsych pres 20121019 al telehealth and broadband

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