S. David McSwain, MD, MPH, FAAP Medical 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 County FFY13 % Outmigration (all ages) BAMBERG100.0% BERKELEY100.0% CALHOUN100.0% LEE100.0% MCCORMICK100.0% SALUDA100.0% FAIRFIELD92.0% DORCHESTER85.5% WILLIAMSBURG83.4% ABBEVILLE82.7% BARNWELL78.8% EDGEFIELD77.8% ALLENDALE74.4% HAMPTON73.9% CHEROKEE67.2% CHESTERFIELD65.2% LAURENS64.8% PICKENS64.3% CLARENDON64.0% JASPER63.5% DARLINGTON62.3% CHESTER60.3% NEWBERRY60.1% MARLBORO59.5% MARION55.7% UNION54.2% KERSHAW53.5% DILLON53.5% LEXINGTON45.0% COLLETON40.2% ORANGEBURG36.7% OCONEE36.0% GEORGETOWN34.6% SUMTER29.3% ANDERSON26.9% LANCASTER25.7% HORRY25.6% BEAUFORT22.6% GREENVILLE16.9% RICHLAND15.8% GREENWOOD11.5% SPARTANBURG10.4% AIKEN10.4% FLORENCE7.9% YORK6.3% CHARLESTON1.1% 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 County FFY13 % Outmigration (Pediatrics) ALLENDALE100.0% BAMBERG100.0% BERKELEY100.0% CALHOUN100.0% LEE100.0% MCCORMICK100.0% SALUDA100.0% WILLIAMSBURG99.5% FAIRFIELD99.4% ABBEVILLE98.0% JASPER97.0% HAMPTON96.8% DORCHESTER96.4% PICKENS94.4% LEXINGTON94.1% EDGEFIELD94.0% CLARENDON89.8% BARNWELL87.4% LAURENS87.4% CHESTERFIELD75.3% UNION72.3% NEWBERRY71.6% CHEROKEE69.9% COLLETON68.0% OCONEE65.4% GEORGETOWN65.1% KERSHAW62.0% MARION61.8% SUMTER59.5% ANDERSON57.0% DARLINGTON56.4% HORRY54.8% ORANGEBURG53.7% BEAUFORT52.7% MARLBORO51.8% CHESTER51.6% LANCASTER43.6% DILLON42.0% SPARTANBURG41.9% GREENWOOD37.3% AIKEN29.6% FLORENCE23.6% YORK16.2% GREENVILLE14.0% RICHLAND5.1% CHARLESTON0.7% 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 years Pediatric 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

Benefits Expedite 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

Accuracy on 5-Point Scale Accuracy of Remote Critical Care Assessments

MUSC Pediatric Emergency and Critical Care Teleconsultations Teleconsultation OutcomeNumber (%) Impacted Triage Decision18/42 (43%) Transferred to a Lower Acuity Setting17/42 (40%) Allowed to Stay at Local Facility/Avoided Transfer (critical care teleconsultations only) 5/47 (11%) Averted Air Transportation5/43 (12%) Allowed Transport by Local EMS Team6/41 (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 ROI1.28

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…