Wednesday, May 27, 2020

Experience in COVID-Specific Psychiatric Unit Highlights Challenges Related to Discharging Patients

The journals of APA Publishing are receiving numerous submissions on aspects of the COVID-19 pandemic. To get information about findings to the field faster, Psychiatric News is posting summaries of these submissions soon after acceptance.

Patients with acute psychiatric needs who are COVID-19 positive can be safely cared for in a COVID-specific psychiatric unit, but determining when they can be discharged can be challenging, wrote Luming Li, M.D., and colleagues at the Yale New Haven Psychiatric Hospital in a Psychiatric Services article in press.

“Emerging evidence suggests that positive test[s] can endure for weeks after a person is no longer infectious,” they wrote. “Although every patient required a COVID+ test … for admission, many patients continue to remain positive or have testing courses with a negative test, positive test, and then inconclusive test, making testing results difficult to interpret.”

The Yale New Haven COVID-specific psychiatric unit was first opened on April 28 after the hospital began to experience an uptick in the number of patients confirmed to have COVID-19 and those suspected of having COVID-19. The adolescent wing of the hospital was converted to a COVID-specific unit after patients in that wing were moved to a unit with young adult patients.

A multidisciplinary leadership team worked to develop a manual to guide the admission criteria for the unit, as well as protocols for infection prevention, use of personal protective equipment, and other issues. To meet criteria for the COVID-specific psychiatric unit, patients needed at least one COVID+ test within the last 14 days and no significant acute medical symptoms. Patients with acute medical concerns continued to be cared for on the general medical unit with psychiatric consultation.

At the time Li and colleagues wrote the paper, 11 patients had been treated in the unit. They noted that since many group living facilities now require two negative tests before patients will be accepted, ongoing positive or variable test results may prove a challenge for discharge. “[P]atients who are acutely stable psychiatrically may need prolonged hospitalizations” due to limited options for discharge, they wrote.

They concluded: “This report helps to outline special considerations for a COVID-specific inpatient psychiatric unit, which can be useful for other behavioral health facilities preparing for infection prevention as states reopen and risk for COVID-19 spread increases.”

The article is in press at Psychiatric Services and can be cited as follows: Li L, Stanley R, Fortunati F: Emerging Need and Early Experiences with a COVID-Specific Psychiatric Unit.

(Image: iStock/SDI Productions)

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