Post on 21-Jan-2016
S. David McSwain, MD, MPH, FAAPMedical Director, Inpatient and Emergency Teleconsultation
Associate Professor, Pediatric Critical Care Medicine
Pediatric Subspecialty Teleconsultation in South Carolina
Prepared by the office of Strategic Planning
Patient Origin CountyFFY13 % Outmigration
(all ages)
BAMBERG 100.0%BERKELEY 100.0%CALHOUN 100.0%LEE 100.0%MCCORMICK 100.0%SALUDA 100.0%FAIRFIELD 92.0%DORCHESTER 85.5%WILLIAMSBURG 83.4%ABBEVILLE 82.7%BARNWELL 78.8%EDGEFIELD 77.8%ALLENDALE 74.4%HAMPTON 73.9%CHEROKEE 67.2%CHESTERFIELD 65.2%LAURENS 64.8%PICKENS 64.3%CLARENDON 64.0%JASPER 63.5%DARLINGTON 62.3%CHESTER 60.3%NEWBERRY 60.1%MARLBORO 59.5%MARION 55.7%UNION 54.2%KERSHAW 53.5%DILLON 53.5%LEXINGTON 45.0%COLLETON 40.2%ORANGEBURG 36.7%OCONEE 36.0%GEORGETOWN 34.6%SUMTER 29.3%ANDERSON 26.9%LANCASTER 25.7%HORRY 25.6%BEAUFORT 22.6%GREENVILLE 16.9%RICHLAND 15.8%GREENWOOD 11.5%SPARTANBURG 10.4%AIKEN 10.4%FLORENCE 7.9%YORK 6.3%CHARLESTON 1.1%
Note: Data based on % of FFY13 hospital discharges outside of patient’s home county; all ages; excludes normal newborns
South Carolina Residents Seeking Inpatient Care at a South Carolina Facility* Outside of their Home County
Source: SCORS
*Data does not account for SC patients discharged at facilities in other states. Aiken County and York County have significant outmigration to Georgia and North Carolina.
South Carolina Pediatric Residents Seeking Inpatient Care at a South Carolina Facility* Outside of their Home County
Patient Origin CountyFFY13 % Outmigration
(Pediatrics)ALLENDALE 100.0%BAMBERG 100.0%BERKELEY 100.0%CALHOUN 100.0%LEE 100.0%MCCORMICK 100.0%SALUDA 100.0%WILLIAMSBURG 99.5%FAIRFIELD 99.4%ABBEVILLE 98.0%JASPER 97.0%HAMPTON 96.8%DORCHESTER 96.4%PICKENS 94.4%LEXINGTON 94.1%EDGEFIELD 94.0%CLARENDON 89.8%BARNWELL 87.4%LAURENS 87.4%CHESTERFIELD 75.3%UNION 72.3%NEWBERRY 71.6%CHEROKEE 69.9%COLLETON 68.0%OCONEE 65.4%GEORGETOWN 65.1%KERSHAW 62.0%MARION 61.8%SUMTER 59.5%ANDERSON 57.0%DARLINGTON 56.4%HORRY 54.8%ORANGEBURG 53.7%BEAUFORT 52.7%MARLBORO 51.8%CHESTER 51.6%LANCASTER 43.6%DILLON 42.0%SPARTANBURG 41.9%GREENWOOD 37.3%AIKEN 29.6%FLORENCE 23.6%YORK 16.2%GREENVILLE 14.0%RICHLAND 5.1%CHARLESTON 0.7%
Prepared by the office of Strategic Planning
*Data does not account for SC patients discharged at facilities in other states. Aiken County and York County have significant outmigration to Georgia and North Carolina.
Note: Data based on % of FFY13 hospital discharges outside of patient’s home county; Age 0-17; excludes normal newborns
Source: SCORS
MUSC Pediatric Emergency and Critical Care Telemedicine Program (PECCT)
$525,943 Duke Endowment grant for three yearsPediatric emergency medicine and critical care subspecialist coverage available 24/7 in community emergency departments
Program designed to serve as foundation for future hospital-based telemedicine programs› Utilizes standard communication platforms to maximize
adaptability› Focusing on integrating existing telemedicine programs at
MUSC into a unified system› Goal is to optimize the ease of implementation for new and
developing programs
Pilot Facilities
Waccamaw Community Hospital
Conway Medical Center
Beaufort Memorial Hospital
Georgetown Memorial Hospital
BenefitsExpedite management and transfer decisions
Reduce the use of unnecessary therapies
Allow suitable patients to stay at their local facility
Ensure appropriate mode of transportation
Improve triage to appropriate location
Lower the cost of care
Improve the comfort level of community physicians in dealing with severely ill/injured children
Overall Diagnosis Respiratory Cardiovascular Neurologic0
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Pediatric Emergency and Critical Care Teleconsultation
Telephone Assessment Accuracy Telemedicine Assessment Accuracy
Accuracy on 5-Point Scale
Accuracy of Remote Critical Care Assessments
MUSC Pediatric Emergency and Critical Care Teleconsultations
Teleconsultation Outcome Number (%)
Impacted Triage Decision 18/42 (43%)
Transferred to a Lower Acuity Setting 17/42 (40%)
Allowed to Stay at Local Facility/Avoided Transfer(critical care teleconsultations only)
5/47 (11%)
Averted Air Transportation 5/43 (12%)
Allowed Transport by Local EMS Team 6/41 (15%)
49 Total Teleconsultations
PICU Admission Rate (telephone critical care consultations): 70%PICU Admission Rate (telemedicine critical care consultations): 51%
Impact on Costs
UC – Davis Pediatric Critical Care Teleconsultation service
• 135 children < 18 years old presenting in highest triage category• 71 telemedicine consults• 64 telephone consults
• Eight rural emergency departments
• 2003 – 2009
• Costs evaluated• Telemedicine operational costs (equipment, maintenance, and
technical support)• ED visit cost• Patient transfer cost• Hospital treatment cost
Yang et al. 2015
Return on Investment
Amount saved from telemedicine consultations ($ per child/ED/year)
$4662
Cost of telemedicine consultations ($ per child/ED/year)
$3641
ROI 1.28
Pediatric Inpatient and Emergency Teleconsultation at MUSC
Currently Available› Pediatric Critical Care› Pediatric Emergency Medicine› Pediatric Burn› Pediatric GI
In Development› Neonatology› Pediatric Cardiac Transplant
MUSC Telehealth Simulation Center
Multi-purpose facility› Telehealth training› Mock consults› Telehealth equipment support› Remote education › Remote simulation› Demonstration› Equipment testing
South Carolina Children’s Hospital Collaborative
South Carolina Children’s Hospital Collaborative Telehealth Network
$1 million over two years to equip all Children’s Hospitals in South Carolina as a teleconsultation hub for their referral regions
Facilitating an integrated, cooperative telehealth infrastructure across the state
• McLeod Children’s Hospital
• Palmetto Health Children’s Hospital
• Greenville Health System Children’s Hospital
• MUSC Children’s Hospital
Statewide Collaboration
Collaborative Leaders
MUSC
• David McSwain, MD, MPH, Medical Director, Inpatient and Emergency Teleconsultation
• Jimmy McElligott, MD, Medical Director, Telehealth
McLeod Health
• Carl Chelen, MD, Chair of Pediatrics
• Hart Smith, Vice President, Patient Services
Palmetto Health
• Brian Gamble, MD, Pediatric Critical Care Medicine
Greenville Health System
• Carley Draddy, MD, Pediatric Hospitalist
• Lynne Teague, MD, Pediatric Urology
South Carolina’s Road to Improved Access
This is not the end…