Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Carolinas HealthCare System

Name of Innovative Program: 
Behavioral Health Access - Telepsychiatry and Behavioral Health Patient Placement
Sponsoring Organization
Carolinas HealthCare System
Name of Innovative Program Lead: 
Christine Zazzaro, MEd, LPC
E-mail Address of Innovative Program Lead: 
christine.zazzaro@carolinashealthcare.org
Physical Address of Innovative Program: 
501 Billingsley Rd, Charlotte, NC 28211
Project Description: 

In our state  of North Carolina there is a huge shortage of psychiatrists. Almost half of the counties in NC have only one or no procticing psychiatrist. We provide emergency telepsychiatry consults to 19 Acute Care Emergency Departments in the Charlotte, NC region. We leverage a small, remote staff to provide this service 19 hours a day, 7 days a week through videoconferencing equipment. We are able to discharge on average 38% of patients who present to the emergency room with a behavioral health crisis. These patients would have had to be transferred to an inpatient facility in order to be evaluated.  With the remaining patients that truly do require psychiatric placement, we have developed a centralized patient placement team that also works from a remote location to search the state for appropriate beds and coordinates the transfer of these patients in an efficient manner. This enables nurses and other ED staff to focus on the direct care of their patients. This is also a small staff  of 7 that does patient placement for 21 different locations accros 7 counties. In January of 2015 we telepsyched and placed over 600 behavioral health patients.  

Creativity and Innovation: 

This department has been able to leverage technology and a small, remote staff to serve a 7 county area efficiently. They have been able to be proponents of change and have helped others to see that excellent patient care can be given by a remote team.  The previous system was very fractured, where multiple EDs were competing for the same beds and were trying to find a bed for a patient with no attention to weather or not is was an appropriate placement. Psychiatrists in our state are a scarce and valuable resourse. We have a system where a liscneced clinician will do the initial assesment of the patient and gather all the pieces of information needed to make a good clinical decision on weather the patient needs admission. The physician can then review  information gathered before speaking with the patient and  allows their time to be spent more efficiently. 

Leadership: 

We strive to be leaders in our state with providing excellent, innovative quality care. We share with others as often as we can what we are doing in order to encourage others to make changes in how they perform treatment. We strive to innitiate behavioral health treatment from the earliest point. That can and should be done in the emergency room if that is where patient presents. Behavioral Health patients should not have to wait days to start back on medications or to be treated for adverse reactions to medications. If we could be the leaders with a new standard of care for behavioral health patients in Acute Care ED's we will have achieved our vision.  

Sustainability: 

Our program is funded and supported through our hospital system. We have been able to show a huge cost savings and return on investment by reducing the overall ED psych hold leangth of stay. This has reduced the sitter expence as well as the increased the oppourtunity to fill beds in the ED with medical patients and not psych patients. Emergency Department care is one of the most expensive levels of care and so to reduce the time spent in an ED bed, even in minutes, is a huge cost savings to the hospital as well as to third party payers.

Replicability: 

With the proper investment in technology and resources, other organizationas could replicate our virtual remote teams. The most important factor in having a program like this suceed is a group of champions and early adaptors that have the vision that great patient care can be achieved by remote access. Any organization with the means to purchase equipment can leverage a small remote team to serve multiple locations.  

Results/Outcomes: 

We created a virtual electronic tracking board that has multiple time stamps in place that allows us to track how long patients are waiting to receive a consult and to also be placed. We track metrics on:  number of consults. time from placing an order to starting a consult, time from when the evaluation was completed to discharge, time from initiating a bed search to identifying a bed and discharge rate after consult. There are almost no benchmarks to compare ourselves to so we make it a priority to measure our metrics and ensure we are doing the best consult in the shortest ammount of time.

Nomination Tags: 
Access
Quality
Cost Savings
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