SCDMH Emergency Department Telepsychiatry Consultation Program
- Need: The shortage of mental health professionals in rural South Carolina resulted in an influx of patients admitted to emergency departments who were in need of psychiatric care.
- Intervention: South Carolina Department of Mental Health partnered with the Duke Endowment to create the SCDMH Emergency Department Telepsychiatry Consultation Program. Rural emergency departments can now reach a psychiatrist to assess a patient via telehealth.
- Results: The program has improved access, affordability, and provided quality care for rural providers and patients with mental illness.
Because of the shortage of mental health professionals in many rural areas of South Carolina, emergency departments (EDs) were experiencing an influx of patients needing psychiatric care. Average wait times were between 48 and 72 hours, and as many as 18% were admitted to the hospital to wait for the mental healthcare professional to arrive.
In response, the South Carolina Department of Mental Health (SCDMH) partnered with the Duke Endowment to create the Partners in Behavioral Health Emergency Services (referred to as the SCDMH Emergency Department Telepsychiatry Consultation Program). This statewide program made it possible for emergency departments to reach a psychiatrist to assess a patient via telehealth.
The goal of the program was to increase access to mental healthcare throughout the entire state, with a focus on underserved and rural communities. What started with 4 hospitals and 6 psychiatrists in 2007 has since expanded to 24 participating hospitals and 15 telepsychiatrists. South Carolina became the first state to successfully connect patients in emergency departments to off-site psychiatrists via telehealth.
Key partners in this program included:
- The Duke Endowment
- University of South Carolina School of Medicine
- South Carolina Department of Health and Human Services
- South Carolina Hospital Association
- South Carolina Budget & Control Board’s Office of Research & Statistics
- Medical College of Georgia
The SCDMH Emergency Department Telepsychiatry Consultation Program received early financial support from the South Carolina Department of Health and Human Services, and initial program support from the South Carolina Hospital Association with ongoing program evaluation from the University of South Carolina School of Medicine.
- Regular availability – Psychiatrists rotate schedules and are available 7 days a week, 18 hours a day from 4 locations (2 in Charleston, Columbia, and Aiken).
- Enhanced Communication – An average daily rate of 15 consultation requests are submitted by ED staff. Prior to the video exchange, the psychiatrist reviews the patient's medical records.
- Assessment via telemedicine – After the encounter, the psychiatrist provides a diagnosis and recommended course of treatment to the patient’s physician in the hospital as well as to the nearest SCDMH community mental health center for follow-up care.
- Training – Participating psychiatrists are provided comprehensive training on how to conduct an evaluation through a telemedicine platform by the medical director. A complete training manual is provided to every physician as a reference.
- Peer Evaluations – Peer reviews are performed quarterly for all telepsychiatry physicians. New psychiatrists are scheduled with experienced physicians until they are comfortable enough to work independently. The medical director and experienced psychiatrists are also available should new psychiatrists have questions.
- IT Support – SCDMH offers 24/7 IT support for the telepsychiatry program.
SCDMH has become the largest provider of telepsychiatry services in the state with more than 72,000 telepsychiatry consultations.
Ongoing evaluations found that the program improved and increased the quality and timeliness of triage, mental health assessment, and initial treatment of patients. Other successes for patients seen through the telepsychiatry program include:
- Higher follow-up and retention of patients seen using telepsychiatry services compared to a those in a control group in an outpatient setting
- Shorter lengths of stay
- Fewer inpatient admissions
- Total charges at the encounter level for the index emergency department visit including subsequent inpatients admissions were significantly lower
Built on the success of the SCDMH Emergency Department Telepsychiatry Consultation Program, SCDMH has equipped its community mental health centers and mental health clinics to provide psychiatric treatment services to its patients via telepsychiatry. Since August 2013, the expanding program has provided more than 36,000 psychiatric treatment services to SCDMH patients throughout South Carolina.
The SCDMH Emergency Department Telepsychiatry Consultation Program is featured in the following publications:
- Statewide Partnership Provides Mental Health Assessments via Telemedicine to Patients in Rural Emergency Departments, Reducing Wait Times, Hospitalizations, and Costs, U.S. Department of Health and Human Services Agency for Healthcare Research and Quality, 2013.
- ED Telepsychiatry Cuts Admissions, Saves Money, American College of Emergency Physicians, 2011.
In 2011, the SCDMH Emergency Department Telepsychiatry Consultation Program received the American Psychiatric Association's Silver Achievement Award.
In the beginning, a general concern raised by established clinicians was the effectiveness of using telemedicine to treat patients. Additional concerns included care coordination logistics, defining responsibilities among clinicians and psychiatrists, and the qualifications of on-call psychiatrists. The SCDMH addressed all of these concerns in a DVD that was sent to all participating medical facilities. Program organizers also followed up with each site in person to discuss additional hesitations, answer questions, and provide additional training.
- Host stakeholder meetings regularly to collaborate, share best practices, and brainstorm ideas for program improvement.
- Implementing telehealth takes adjustment for any healthcare professional. While it's good to recruit from medical schools, be sure to also hire experienced psychiatrists who can guide new psychiatrists through virtual consultations.
- When building partnerships with hospitals, look for those who already have a strong relationships with their community mental health centers and other agencies that can quickly take referrals following a telepsychiatry consultation.
- Be intentional with follow-up care for patients. Involve family members and caretakers, and ensure that patients take the next steps recommended by their psychiatrist.
- Broaden your partnerships to include those at the healthcare, academic, and state levels. Having these representatives involved with a telemedicine program, whether through delivery of care, recruitment, or policy, can enhance its effectiveness.
D. Stewart Cooner, MHA, Director of Special Programs/Telepsychiatry
SCDMH Division of Medical Affairs
SCDMH Emergency Department Telepsychiatry Consultation Program
Emergency department and urgent care services
December 5, 2017
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.