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

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.

Preparing for patients who need seclusion and restraint: Trivedi said his system has taken steps to prepare for cases in which patients who are COVID-19 positive require seclusion or restraints. The protocol for these patients includes steps to ensure all staff use the appropriate personal protective equipment (PPE). “We are making plans for what to do in that situation long before we’re in that situation, so staff are prepared and know what to do,” he said.

Restricting outside visitor access: Ghinassi said his system’s inpatient units and screening facilities have stopped allowing visitors. The only plausible exception to this protocol is pediatric patients, some of whom are as young as 6 or 7, and for whom visitors are allowed on a case-by-case basis. “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 PPE selectively: 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: Trivedi, Kimmel, and Ghinassi all spoke of the importance of providing staff with regular updates on new information learned and changes taking place in response to COVID-19. 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.

“If people feel uninformed, they somehow feel information is being withheld or they’re being left out of the loop,” Ghinassi said. Even if people don’t agree with the changes, he continued, receiving regular updates helps them feel that they’re part of the process.