Faculty at both the University of South Carolina (USC) and the Medical University of South Carolina (MUSC) are working to transform access to specialists and reduce health disparities through the use of telemedicine. Rural communities throughout South Carolina and the United States can present special challenges for patient care, often centered around limitations in access to specialized care in Emergency Department settings. This can also lead to significant health disparities which contribute to poor outcomes.
A federally funded program involving MUSC and select hospitals in the Lowcountry and Pee Dee regions was established under the acronym CREST (Critical Care Excellence in Sepsis and Trauma) by Dr. Dee Ford and Dr. Samir Fakhry.
Using telemedicine, MUSC staff and participating hospitals’ staff have an audiovisual connection enabling them to see and hear each other, as well as the patient, resulting in a more thorough evaluation and documentation. “Roughly half of the 40,000 annual traffic fatalities occur at the scene,” said Fakhry, professor of surgery and chief of the MUSC Division of General Surgery. “But if you survive that, your best chance of survival occurs within the first hour or two, what we call the Golden Hour. The focus in trauma care has always been to get the patient to the appropriate level of care in the shortest possible time.”
South Carolina leads the nation in the percentage of rural highway fatalities, according to a 2011 study, and as Fakhry points out, the state’s trauma centers are in urban areas, where they are most needed. To overcome that hurdle, Ford and Fakhry, armed with a grant from the National Institutes of Health, approached several hospitals in 2009 with a proposal to establish a telemedicine network linking MUSC’s emergency department with rural hospitals.
“You couldn’t put an expert trauma surgeon and an expert in critical care in every emergency department,” Fakhry said. “However, with telemedicine, we could make that expertise available and make it affordable in these remote locations.” Six MUSC trauma surgeons and four pulmonary/critical care physicians were available to consult with the rural hospitals 24 hours a day, 365 days a year.
Likewise, identifying unmet needs across the state, Dr. Meera Narasimhan, vice dean for Innovative Healthcare Technologies and professor and chair of the Department of Neuropsychiatry and Behavioral Science at the USC School of Medicine Columbia, has led a statewide telepsychiatry initiative providing emergency psychiatric care access 24 hours a day, 365 days a year. A psychiatrist provides assessment and recommendations for initial treatment and works closely with the emergency room physician to identify resources in the community to help the patient with follow-up care. Patients who receive quality follow-up care are less likely to need re-hospitalization and often enjoy an improved quality of life.
Recently Dr. Narasimhan was awarded a $2.7 million grant from the National Institutes of Health (NIH) to study telepsychiatry in emergency rooms. The NIH-funded study is a partnership between the University of South Carolina, South Carolina Department of Mental Health, SC Office of Research and Statistics, and Emory University. The study will evaluate the healthcare utilization, quality, sustainability, and economic impact of an existing statewide telehealth initiative that is providing care in emergency departments throughout South Carolina. In addition, the study will determine whether the organizational model should be provided nationally.