Skip to main content

SCDMH Emergency Department Telepsychiatry Consultation Program

Summary 
  • 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 (SCDMH) partnered with The Duke Endowment to create the SCDMH Emergency Department Telepsychiatry 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.

Description

Because of the shortage of mental health professionals in many rural areas of South Carolina, emergency departments (EDs) were experiencing an influx of patients in need of psychiatric care. Average wait times were between 48 and 72 hours, and as many as 18% of these patients were admitted to the hospital to wait for a 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 Program). This statewide program made it possible for emergency departments to reach a psychiatrist to assess a patient via telehealth.

SCDMH Emergency Department Telepsychiatry Consultation Program

The Program's goal 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 22 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 include:

The SCDMH Emergency Department Telepsychiatry 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. Today, the Program is supported by a combination of state appropriations, grants, and earned revenue.

Services offered

The following services are included with the ED Telepsychiatry program:

  • Regular availability – Psychiatrists rotate schedules and are available 7 days a week, 18 hours a day from 4 locations (Charleston (2), Columbia, and Aiken).
  • Enhanced Communication – ED staff submit an average daily rate of 24 comprehensive evaluation requests. Prior to the video exchange, the SCDMH psychiatrist reviews the patient's medical records.
  • Assessment via telemedicine – After the encounter, the SCDMH 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 – The Program's medical director provides comprehensive training on how to conduct an evaluation through a telemedicine platform to participating psychiatrists. A complete training manual is provided to every physician for reference.
  • Peer Evaluations – Peer reviews are performed quarterly for all SCDMH telepsychiatry physicians. New psychiatrists are scheduled with experienced physicians until they are comfortable enough to work independently. The Program's 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.

In addition to the ED Telepsychiatry program, SCDMH offers 5 other telepsychiatry programs:

  • Deaf Services Telepsychiatry
  • Community Telepsychiatry
  • The EMS Telehealth Pilot Project
  • Inpatient Services Telepsychiatry
  • School Mental Health with Telepsychiatry Component

Results

SCDMH is the largest provider of telepsychiatry services in the state. Their 6 telehealth programs have provided more than 104,000 psychiatric services rendered via telehealth.

Ongoing evaluations have found that the Program has 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
  • Significantly lower total charges at the encounter level for the index emergency department visit including subsequent inpatients admissions
  • The average wait time for first quarter FY2019 reduced to 5.75 hours, with outliers.

Built on the success of the SCDMH Emergency Department Telepsychiatry 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 58,000 psychiatric treatment services to SCDMH patients throughout South Carolina.

The Program is featured as a Service Delivery Innovation Profile on the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality website: Statewide Partnership Provides Mental Health Assessments via Telemedicine to Patients in Rural Emergency Departments, Reducing Wait Times, Hospitalizations, and Costs.

In 2011, the SCDMH Emergency Department Telepsychiatry Program received the American Psychiatric Association's Silver Achievement Award.

Barriers

In the beginning, the effectiveness of using telemedicine to treat patients was a general concern raised by established clinicians. Additional concerns included care coordination logistics, definition of responsibilities among clinicians and psychiatrists, and the qualifications of on-call psychiatrists. The SCDMH addressed all of these concerns in a DVD sent to all participating medical facilities. Program organizers also followed up in person with each site to discuss additional hesitations, answer questions, and provide additional training.

Replication

  • 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 that already have a strong relationship with their community mental health centers and other agencies that can take referrals quickly following a telepsychiatry evaluation.
  • Be intentional with follow-up care for patients. Involve family members and caretakers, and ensure that patients take the next steps recommended by their psychiatrists.
  • 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.

Contact Information

D. Stewart Cooner, MHA, Director of Special Programs & Telepsychiatry
SCDMH Division of Medical Affairs
SCDMH Emergency Department Telepsychiatry Consultation Program
803.898.8632
stewart.cooner@scdmh.org

Topics
Emergency department and urgent care services
Healthcare workforce
Mental health
Telehealth

States served
South Carolina

Date added
December 5, 2017

Date updated or reviewed
December 14, 2018


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.