using telemedicine for psychiatric consults in the emergency

Sy Saeed, M.D., MS, FACPsych Professor and Chairman Department of Psychiatry and Behavioral Medicine Brody School of Medicine - East Carolina University

Director North Carolina Statewide Telepsychiatry Program (NC-STeP)

NCStatewideUseofTelemedicineforPsychiatricConsultsintheED

October 25, 2016

Mentaldisordersarecommon

•  Anes&mated26.2%ofAmericansages18andolder(about1in4)Americanshaveamentaldisorderinanyoneyear1.– Whenappliedtothe2004U.S.Censusresiden&alpopula&ones&mateforages18andolder,thisfiguretranslatesto57.7million2.

•  Themainburdenofillnessisconcentratedinamuchsmallerpropor&on—about6percent,or1in17(13.2million)—whosufferfromaseriousmentalillness1.

1.  KesslerRC,ChiuWT,DemlerO,WaltersEE.Prevalence,severity,andcomorbidityoftwelve-monthDSM-IVdisordersintheNa&onalComorbiditySurveyReplica&on(NCS-R).ArchivesofGeneralPsychiatry,2005Jun;62(6):617-27.

2.  U.S.CensusBureauPopula&onEs&matesbyDemographicCharacteris&cs.Table2:AnnualEs&matesofthePopula&onbySelectedAgeGroupsandSexfortheUnitedStates:April1,2000toJuly1,2004(NC-EST2004-02)Source:Popula&onDivision,U.S.CensusBureauReleaseDate:June9,2005.hap://www.census.gov/popest/na&onal/asrh/

•  InrecentyearsNorthCarolinahasseenhighemergencydepartmentadmissionsrelatedtobehavioralhealthissuesandextendedlengthsofstays(LOS),rangingfromlonghourstomul&pledays1.

•  AccordingtotheNorthCarolinaHospitalAssocia&on,in2013,NChospitalshad162,000behavioralhealthemergencydepartmentvisits.

•  In2010,pa&entswithmentalillnessmadeupabout10percentofallemergencyroomvisitsinNorthCarolina,accordingtoastudybytheCentersforDiseaseControl,andpeoplewithmentalhealthdisorderswereadmiaedtothehospitalattwicetherateofthosewithout.

1.  Akland, G. & Akland, A. (2010). State psychiatric hospital admission delays in North Carolina. (http://naminc.org/nn/publications/namiwakerpt.pdf.)

•  Currently, there are 108 hospitals with either single ED’s, or in some cases, multiple site ED’s across the state with varying degrees of psychiatric coverage.

•  The majority of ED’s do not have access to a full-time psychiatrist.

Telepsychiatry is defined in the statute as the delivery of acute mental health or substance abuse care, including diagnosis or treatment, by means of two-way real-time interactive audio and video by a consulting provider at a consultant site to an individual patient at a referring site.

This statewide program was developed in response to Session Law 2013-360 directing the N.C. Department of Health and Human Services' Office of Rural Health and Community Care to "oversee and monitor establishment and administration of a statewide telepsychiatry program.” (G.S. 143B-139, 4B).

General Assembly of North Carolina Session 2013 Session Law 2013-360 Senate Bill 402

Ifanindividualexperiencinganacutebehavioralhealthcrisisentersanemergencydepartment,s/hewillreceive&melyspecializedpsychiatrictreatmentthroughthestatewidenetworkincoordina&onwithavailableandappropriateclinicallyrelevantcommunityresources.

•  71hospitalsinnetwork•  56hospitalcurrentlylive•  2hospitalsreadytogolive,wai&ngoncreden&aling•  13addi&onalhospitalsinprocess(i.e.contractnego&a&ons,equipmentbeingordered,etc)

•  Over12,000totalTelepsychiatryAssessmentshavebeenconductedundertheprogramsinceitsincep&oninOctober2013.

389

174

64

552

69

164

391

196

370

150

1

215

8

932

254 276 279

3468

21 43 65

2

85

236

12 33 332 17

0

100

200

300

400

500

600

700

800

900

1000

TotalNumberofEDTelepsychiatryPa?entsbyhospital-forJanuary-December2014

NumberofTelepsychiatryPa&entsbyHospital

Albemarle8% Beaufort

3%

Ber&e1%

Carteret11%

CarolinaEast1%

Chowan3%

Duplin8%

Edgecombe4%

Lexington7%

Mar&n3%

OuterBanks4%

Randolph18%

Wayne5%

Wilson5%

Lenoir5%

Nash1%

Bladen1%

Washington0%

WesleyLongCone1% AnniePenn

1%MosesCone2%

MedCenterHighPoint0%

McDowell5%

NovantKernersville

0%

BlueRidge1%

Transylvania1%

St.Lukes0%

Yadkin0% Pungo

0%

HospitalEDsandPercentofUse-January-December2014

40%

54%

.8

.4 4% PercentofTelepsychiatryPa?entsbyDischargeDisposi?on

April-June2015

Median Length of Stay for Jan 2014 – Dec 2014 = 23.6 Hours

62% percent of patients Had a LOS of 30 hours or less

Number of patients with a LOS in this category

En?ty CostSavings

Pa&entsandFamilies Howtoquan&fyreduceddistress/disability,func&onalimprovement,qualityoflife,gainfulemployment,etc.

Communi&es Howtoquan&fybeaer"ci&zenship”,reducedhomelessness,crimereduc&on,moreselfreliance,etc.

NC-Medicaid+“IndigentCare”(?MCOs)

NCStateprojectedcostsavingsfromoverturnedIVC'sforself-payandMedicaid=$4,441,239Costsavingsfromreducedrecidivism=?

ThirdPartyPayors ProjectedcostsavingsfromoverturnedIVC's=$1,133,261Costsavingsfromreducedrecidivism+?

SheriffDepartment ProjectedcostsavingstoSheriffDepartmentfromoverturnedIVCs=$535,404

Hospitals CostssavingsfromincreasedthroughputintheED.

•  Telepsychiatryisaviableandreasonableop&onforprovidingpsychiatriccaretothosewhoarecurrentlyunderservedorwholackaccesstoservices.

•  Thecurrenttechnologyisadequateformostusesandcon&nuestoadvance.

•  Overcomingthebarrierstoimplementa&onwillrequireacombina&onofconsumer,provider,andgovernmentaladvocacy.

•  It’saboutrela&onships,nottechnology

Sy Saeed, M.D., M.S., FACPsych Professor and Chairman Department of Psychiatry and Behavioral Medicine Brody School of Medicine | East Carolina University Director North Carolina Statewide Telepsychiatry Program (NC-STeP) Phone: 252.744.2660 | e-mail: saeeds@ecu.edu | Website: http://www.ecu.edu/psychiatry Mail: Brody School of Medicine, 600 Moye Boulevard, Suite 4E-100, Greenville, NC 27834

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