using telemedicine for psychiatric consults in the emergency
TRANSCRIPT
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: [email protected] | Website: http://www.ecu.edu/psychiatry Mail: Brody School of Medicine, 600 Moye Boulevard, Suite 4E-100, Greenville, NC 27834
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