Friday, April 3, 2020

Speakers Share Insights on Inpatient Psychiatric Care During COVID-19 Pandemic

Inpatient psychiatric units all over the country are grappling with the need to continue treating patients in the midst of the coronavirus (COVID-19) pandemic. On Wednesday, APA and the National Association for Behavioral Healthcare hosted a webinar with the leaders of three inpatient facilities so they could share their experiences so far.

The leaders were Harsh Trivedi, M.D., M.B.A., president and CEO of Sheppard Pratt Health Systems in Maryland; Ryan Kimmel, M.D., chief of psychiatry at the University of Washington Medical Center; and Frank A. Ghinassi, Ph.D., A.B.P.P., president and CEO of Rutgers University Behavioral Health Care. APA Education Director Tristan Gorrindo, M.D., moderated the webinar.

The speakers stressed the importance of addressing COVID-19 in health systems in a way that does not limit people’s access to behavioral health care. “We’re trying not to reduce our inpatient psychiatry footprint,” Kimmel said. “If anything, we’re trying to increase it.”

The participants outlined strategies they’ve adopted to deliver psychiatric care during the COVID-19 crisis, including the following:

Setting up remote services wherever possible: The participants explained that their systems have worked to rapidly provide outpatient services through telemedicine.

Trivedi said Sheppard Pratt is working to launch a virtual assessment service for patients in crisis. When patients on inpatient wards test positive for COVID-19, Ghinassi said his staff use video technology to allow patients to participate in educational and group activities from their rooms.

Restricting outside visitor access: Ghinassi said his system’s inpatient units and screening facilities have stopped allowing visitors. The only exception to this protocol is pediatric patients, some of whom are as young as 6 or 7. The policy allows visitors on a case-by-case basis, but “as difficult as it is, we have not allowed more than one or two of those visits to actually happen,” he said. “We are making ample access to video technology … to allow the parents to visit virtually, but visiting has, for all practical purposes, ceased on any of our units.”

The system has also started doing temperature scans of everybody who comes in and out of the buildings on a daily basis, Ghinassi said.

Using personal protective equipment (PPE) carefully: Typically, on inpatient psychiatric units, plastic biohazard bags or PPE supplies that could be used as ligatures must be stored where patients cannot access them, Kimmel explained.

“On our inpatient unit we’ve had to develop systems where inside the patient’s room is a locking closet, to which the staff has a key but the patient doesn’t, where we store some of the supplies and the biohazard bags,” he said.

Supporting staff: Communication has been essential for each of the participants and their staffs, they said. Information from the Centers for Disease Control and Prevention and local departments of health changes rapidly, they said, and strong lines of communication with staff are vital. Kimmel said the University of Washington Medical Center has set up a peer-to-peer program to support staff.

“We are all human beings, and we are all relationship-based,” Trivedi said. “Within our messages we ask: How do we take the time to support one another?”

(Image: iStock/baona)

APA’s COVID-19 Resource Center Keeps You Updated

APA’s COVID-19 Resource Center brings together a number of useful resources from APA and other authoritative sources to help you deal with the COVID-19


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