Management of the COVID-19-Infected Psychiatric Inpatients: Unique Infection Prevention Considerations and Evolving Strategies

Abstract

Reason for Review The COVID-19 pandemic has affected the way healthcare services are provided and created challenges to the delivery of behavioral health in the inpatient setting. Here, we present our front-line experience of infection prevention for the psychiatric patient in the COVID era. Recent Findings There are unique challenges surrounding COVID-19 precautions within inpatient psychiatric settings. The challenges presented to psychiatric care by COVID-19 begin in the emergency department and follow the patient through the continuum of care once admitted to the facility. Unit infrastructure, patient population, treatment modalities, staffing considerations, and discharge planning are distinct instances where COVID-19 protocols that are well-suited for other hospital settings necessitate revision for psychiatric settings. Summary The purpose of this communication is to add to the current body of shared experience of infection prevention for the psychiatric patient in the COVID-19 era.

A retrospective review of COVID-19 testing and mitigation strategies at a psychiatric hospital and subsequent COVID-19 acquisition

“…Existing studies feature information about COVID-19 outbreaks and mitigation strategies in psychiatric hospitals and warn about additional transmission risks that patients face due to the type of care being received and diagnoses. 5 , 6 A New York psychiatric hospital implemented universal asymptomatic screening tests of admitted patients when the community reached significant transmission levels, 7 but due to lower testing capacity early on, some facilities only tested and isolated patients with confirmed exposures or symptoms, rather than trying to prevent transmission from asymptomatic carriers. 8 There is limited published data on the effectiveness of other infection prevention interventions to prevent SARS-CoV-2 transmission in behavioral health settings.…”

Proactive use of QI methodology in consultation-liaison psychiatry to support the opening of a new COVID+ behavioral health inpatient unit during the omicron surge

“…The COVID-19 pandemic had a significant impact on this process when inpatient psychiatric units were unable to provide care for patients with asymptomatic COVID-19 infection because of infection control concerns in units unable to accommodate isolation precautions [ 1 , 2 ]. Similar to other disrupted hospital workflows, these clinical handoffs became more complicated by requiring COVID exposed or COVID+ patients in the midst of behavioral health crisis to quarantine or isolate on general hospital units if not otherwise stable for discharge to the community [ 3 ]. To better respond to the growing number of patients isolating in the general hospital during the 2022 Omicron surge, we used quality improvement (QI) methodology to illustrate the need to create a COVID+ unit in the inpatient psychiatric hospital to care for the growing cohort of COVID+ patients in psychiatric crisis who were otherwise unable to access traditional psychiatric hospital care because of their isolation status.…”

“…The COVID-19 pandemic has drastically impacted many aspects of psychiatric care access, including the throughput of patients awaiting transfer to the psychiatric hospital from general hospital settings [ 1 , 2 , 6 ]. These barriers to crisis care were exacerbated by rapidly evolving surges in viral variants and fluctuating epidemiologic requirements for managing milieu-based inpatient settings [ 3 ]. Tracking and reporting this shifting data in real time required adaptation of existing tools to better measure the impact of the Omicron surge.…”