PurposeThe COVID-19 pandemic has actively changed the face of all medical disciplines, including mental health practices. In a matter of days from the introduction of the lockdown, clinicians have to adapt to new working models with many changing the consultation methods clinicians have utilized for years. To best understand the wider clinical impact, a limited study was carried out to assess the effect of coronavirus disease 2019 (COVID-19) on psychiatric clinical practice.Design/methodology/approachA qualitative study was performed to analyze the impact of COVID-19 on clinician practice at a UK secure care mental health facility. A four-question free-text survey was distributed online to all physicians and seven responses were analyzed using thematic analysis.FindingsFour key themes were identified – use of technology, the importance of face-to-face contact, work/life balance and mental well-being.Practical implicationsOverall, the results of the study reported that although some negative changes to the traditional work–life balance were identified, the clinicians found remote working within a secure care setting cultivated a more efficient working environment while allowing for more effective social distance practices.Originality/valueThis study highlighted some of the challenges faced by clinicians employed in a secure care mental health setting following the introduction of lockdown measures in the UK associated with the COVID-19 pandemic. The study will also inform future work practices, including the potential of longer term remote working in this sector.
IntroductionThe Jackson Hospital Crisis (Psychiatric ED) Center serves the entirety of Miami-Dade County in Florida and is considered one of the top three busiest and per capita of clinical staff likely the busiest nationally across the United States. Simultaneously, the management of mental health emergencies has ascended near the top of international priorities driven by multiple trends (e.g., growing social isolation associated with the pandemic, de-stigmatization). The crisis environment presents a uniquely difficult challenge in applying high quality medical care: frequent suicidal gestures, impulsive often intoxicated or psychotic patients, unprecedented demand, diminishing staff capacity, and requirements to consistently apply specific medical and psychiatric protocols. These challenges are specifically difficult for new trainees who are not yet accustoms to the high acuity situations found in psychiatry. Moreover, academic, institutional, and governmental policies change on a monthly, or even weekly basis, often with the objective of improving care. Nevertheless, such constant shifts in workflow result in opportunities for errors that impact patient trajectories.ObjectivesAs such we endeavored to apply an evidence-based approach to improving the likelihood of success. One such vetted approach, the use of checklists, benefits from 10+ years of peer-reviewed research in “operational” medical specialties (e.g., surgery, ED, ICU) where work is segmented around interventions or time-shifts which share commonalities with the Psychiatric ED model. Yet the difficulty in implementing such models is typically not in the “hard” aspects of defining the checklist, but in the “soft” implementation dimensions of syndication, distribution, and enablement in the context of the individual unique settings.MethodsWe developed a checklist that will be implemented on the Jackson Crisis emergency department, with the aim of having first year trainees complete the check list on each individual patient. Surveys were administered before implementation of checklist and will be distributed on a quarterly basis to trainees to evaluate for changes in resident confidence and clinical care.ResultsOver six months, we launched this initiative with drivers of adoption focused on accelerating and easing new resident training, safety incident targeting, and in the balancing of “push” top/down and “pull” bottom/up dynamics. Initial learnings include rapidly improving resident satisfaction as well as various other impacts currently being observed throughout the institution.ConclusionsOverall reception to the checklist has been positive from attendings and new trainees alike, further evidence will be analyzed and presented as the checklist is utilized throughout the psychiatric ED.Disclosure of InterestNone Declared
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