1. South Carolina Department of Mental Health (DMH) Division of Medical Affairs Telepsychiatry Consultation Program Achieving Tomorrow, Today Last Update: 03/31/20141 Trends In Healthcare: Telemedicine Use in Emergency Departments, A Behavioral Health Solution

2. Last Update: 04/18/20132 Overview the Problems – Patient Back-up in the Emergency Department (ED) the Problems – Patient Back-up in the Emergency Department (ED) the Partnerships – the Partnerships – The Duke Endowment, SC Department of Health and Human Services, SC Department of Mental Health, and the SC Hospital Association The Duke Endowment, SC Department of Health and Human Services, SC Department of Mental Health, and the SC Hospital Association the Proposal – an initial Three-year Grant the Proposal – an initial Three-year Grant the Purpose – Achieving Tomorrow, Today the Purpose – Achieving Tomorrow, Today

3. Last Update: 12/07/20123 Primary Goals Timely Psychiatric Assessment and Rapid Initiation of Treatment Timely Psychiatric Assessment and Rapid Initiation of Treatment Increased Quality of Care Increased Quality of Care Reduced Lengths of Stay (LOS) Reduced Lengths of Stay (LOS) Comprehensive Discharge Planning Comprehensive Discharge Planning Savings to the Hospital and Community Savings to the Hospital and Community

4. Last Update: 08/25/20144 Remote Site Locations

5. Last Update: 08/25/20145 Clinical Office Locations Columbia, SC (2) Aiken, SC (2) Charleston, SC (2) Anderson, SC Conway, SC * Spartanburg, SC * * FUTURE

6. Last Update: 04/18/20136 Consultation Process Patient Presents in ED Patient Presents in ED ED Physician Requests Consult ED Physician Requests Consult Psychiatrist Reviews CIS/SCHIEx, EMR Psychiatrist Reviews CIS/SCHIEx, EMR Patient Consulted Patient Consulted Video Encounter Ends Video Encounter Ends Psychiatrist Electronically Signs Consult Psychiatrist Electronically Signs Consult Recommendations Sent to ED Recommendations Sent to ED Hospital Dispositions the Patient Hospital Dispositions the Patient

7. Last Update: 08/25/20147 Dashboard - Time Current program results: 42% recommended for discharge the same day (24-48 hours) of consultation Current program results: 42% recommended for discharge the same day (24-48 hours) of consultation Comparing end of first quarter CY 2009 (pre-Telepsychiatry) to end of CY 2013 (Telepsychiatry) for Mental Health Patients in SC ED’s… Comparing end of first quarter CY 2009 (pre-Telepsychiatry) to end of CY 2013 (Telepsychiatry) for Mental Health Patients in SC ED’s… Overall Patient Wait Times for Inpatient Admissions were down by 46% Overall Patient Wait Times for Inpatient Admissions were down by 46%

8. Last Update: 08/25/20148 Turn-Around 10.6 hours from initial ED request for Telepsychiatry to transmission of patient recommendations (CY 2014 to date) 10.6 hours from initial ED request for Telepsychiatry to transmission of patient recommendations (CY 2014 to date) Compared to 2-4 days, pre-Telepsychiatry Compared to 2-4 days, pre-Telepsychiatry 10.6 consults every 16 hour day (CY 2014 to date) 10.6 consults every 16 hour day (CY 2014 to date) Compared to 1-4 consultations by local MHC MHP’s (post-weekend) during a 8 hour day Compared to 1-4 consultations by local MHC MHP’s (post-weekend) during a 8 hour day

9. Last Update: 02/03/20149 Satisfaction Surveys

10. Survey Results – Patients Positive Impact on Patients… Positive Impact on Patients… 90.7% of ED Staff state Telepsychiatry is an efficient use of Patient’s time; 90.7% of ED Staff state Telepsychiatry is an efficient use of Patient’s time; 95.3% of ED Staff state Patients appear comfortable during consultations; and, 95.3% of ED Staff state Patients appear comfortable during consultations; and, 95.4% of ED Staff state Patients are cooperative during the consultation 95.4% of ED Staff state Patients are cooperative during the consultation Last Update: 03/201410

11. Survey Results - EDs Benefits to the Emergency Departments… Benefits to the Emergency Departments… 83.4% of ED Physicians state Telepsychiatry is an efficient use of ED Staff’s time; 83.4% of ED Physicians state Telepsychiatry is an efficient use of ED Staff’s time; 100% of ED Physicians state they are satisfied with the availability of Telepsychiatry; 100% of ED Physicians state they are satisfied with the availability of Telepsychiatry; 100% of ED Physicians state they are satisfied with the thoroughness of consults; and, 100% of ED Physicians state they are satisfied with the thoroughness of consults; and, 83.3% of ED Physicians state they are satisfied with disposition recommendations 83.3% of ED Physicians state they are satisfied with disposition recommendations Last Update: 03/201411

12. Survey Results - Administration Efficient Use of Hospital Resources… Efficient Use of Hospital Resources… 94.4% of Hospital Administrators state the program is an efficient use of hospital funds; 94.4% of Hospital Administrators state the program is an efficient use of hospital funds; 94.4% of Hospital Administrators would recommend the program to other Hospitals 94.4% of Hospital Administrators would recommend the program to other Hospitals Last Update: 03/201412

13. Last Update: 08/25/201413 R01 Grant Research Collateral Effect: Reallocation of Resources by ED’s to ED-appropriate care Collateral Effect: Reallocation of Resources by ED’s to ED-appropriate care Reduced Commitment Rate to BH Inpatient Beds Reduced Commitment Rate to BH Inpatient Beds Reduction in Average Inpatient LOS Reduction in Average Inpatient LOS Produced Savings of $1,400 in BH Inpatient Settings per Care Episode Produced Savings of $1,400 in BH Inpatient Settings per Care Episode Equals (approx.) $28.4 M in BH Inpatient Savings Equals (approx.) $28.4 M in BH Inpatient Savings

14. Last Update: 04/18/201314 Website

15. Last Update: 09/16/201315 For more information, please visit: www.scdmh.org/telepsychiatry or contact our program office: Ed Spencer, M.Ed. MSW, Program Director (803) 898-8579 Ralph Strickland, Coordinator rns42@scdmh.org