key: cord-0756459-abuz940t authors: Mahgoub, Nahla; Agarkar, Smita; Radosta, Michael; Fakih, Francine; Calleran-Bedosky, Brynne Delaney; Clark, Robert; Cherubin, Deborah; Faour, Faraj; Anthony, Donna title: Inpatient psychiatry unit devoted to COVID-19 patients date: 2021-03-09 journal: Compr Psychiatry DOI: 10.1016/j.comppsych.2021.152237 sha: 70d7a5dc5b3a1bf983c5e62fdbc32501f30e8037 doc_id: 756459 cord_uid: abuz940t The COVID-19 pandemic has significantly changed the mental health care. Treating psychiatric patients with COVID-19 poses multiple challenges in the inpatient psychiatric setting in terms of mitigating transmission of the virus. Gracie Square Hospital, a freestanding psychiatric hospital located in New York City, dedicated a unit for treating COVID-19 patients requiring inpatient psychiatric treatment. We faced different challenges including treatment refusal, difficulty complying with safety precautions due to psychosis, agitated behavior, and staff psychological well-being. We considered reformation of protocols, expansion of the use of technology, development of a supportive platform, and standardization of clinical practice. This paper describes our strategies to manage the challenges while providing acute psychiatric treatment to COVID-19 patients. While implementing the CDC recommendations, we faced the following challenges among psychiatric patients: lack of mental capacity to give consent to treatment, impaired judgment, treatment refusal, uncooperativeness, difficulty complying or comprehending social distancing, aggression, psychosis, and worsening psychiatric symptoms due to COVID-19 outbreak. At times, behavioral dysregulation made it impossible for patients to adhere to isolation precautions. Some patients contravened precautions, for instance, by spitting during agitated episodes or drinking the alcohol-based hand sanitizer. Accordingly, Gracie Square Hospital converted one of its general psychiatric units into a psychiatric COVID unit. The unit was dedicated entirely to treating COVID-19 patients who need psychiatric care with the goal of minimizing the risk of exposure to patients and staff. This conversion process was executed in a timely manner considering the rapidly evolving outbreak. The hospital designated a multidisciplinary team to meeting the complex needs of this unique patient population. Moreover, the department of Infection Prevention and Control (IPC) at NYP was providing ongoing clinical advice including clinical protocols and consultation on individual patient cases. Bed capacity: the identified unit has a bed capacity of 35, with 10 beds inside a separate suite on both sides of the unit. These suites were separated from the main hallway through a door on either side. This enabled us to first isolate COVID-19 patients in two separate suites with a total capacity of 20 beds. Once one suite was filled, we proceeded to fill the other one. It was decided to admit only COVID-19 patients to these suites to avoid exposure to other patients. As the J o u r n a l P r e -p r o o f Journal Pre-proof outbreak in New York City worsened and the hospital started getting more COVID-19 patients, we had to then convert the entire 35 beds into a COVID-19 unit. Source of referral: all COVID-19 patients were referred from the emergency rooms and inpatient medical units of other hospitals in New York City. Moreover, patients who turned positive on a non-COVID-19 unit at our hospital were transferred to the psychiatric COVID-19 unit. We also received patients from other inpatient psychiatric units which were converted to critical care service. Admitting process: patients were seen in the admitting suites by medicine and psychiatry for severity of their symptoms. All patients must wear a face mask once they step into the admitting suite. If a COVID-19 patient refuses to wear a mask because of agitation or florid psychosis, emergency medications would be administered to maintain behavioral control and prevent spread of the virus. When transferring a newly admitted patient from the admitting suite to the unit, a security officer must be present along with nursing staff to ensure patient's compliance with the safety measures. and prevent complications. In October 2020, The FDA approved the antiviral drug; remdesivir, for the treatment of COVID-19 patients but should only be administered in a hospital setting capable of providing acute clinical care (12) . Fifteen patients turned positive during their hospital stay on the non-COVID-19 units of our hospital and they were transferred to the psychiatric COVID-19 unit. The peak census was 26 patients. At time of admission, all patients presented with typical symptoms of fever, cough and sore throat but not medically ill enough to be hospitalized on the medical floor. During the hospital course, ten patients were converted to negative and eight patients were transferred to the emergency room for respiratory complications. Forty patients were discharged to the community. All staff on the psychiatric COVID-19 unit remained negative once the unit was established. COVID-19 pandemic has dramatically changed psychiatric practice over a short period of time given the level of clinical uncertainty and unique circumstances. The unprecedented task of preventing and managing COVID-19 transmission on the inpatient psychiatric setting requires development of contingency plans to address the distinctive challenges encountered within this patient population (19) . As inpatient psychiatry continues to accustom to this pandemic, health care facilities need to share their expertise and strategy in attempt to mitigate the virus transmission. Although research during a public health crisis can be difficult (4), longitudinal studies can be conducted to examine the effectiveness of dedicating a psychiatric unit for COVID-19 patients in reducing morbidity and mortality related to the virus while delivering acute psychiatric care. Disclosure and acknowledgment: All authors have no conflicts of interest and did not receive any financial support from any organization regarding the content of this paper. pdf#:~:text=On%20March%2011%2C%202020,COVID%2D19%20Outbreak COVID-19 and mental health. The lancet Psychiatry Psychiatry and COVID-19 Airborne Transmission Route of COVID-19: Why 2 Meters/6 Feet of Inter-Personal Distance Could Not Be Enough Review of the 2019 novel coronavirus (SARS-CoV-2) based on current evidence Review of the 2019 novel coronavirus (SARS-CoV-2) based on current evidence COVID-19) as a Multi-Systemic Disease and its Impact in Low-and Middle-Income Countries (LMICs). SN Compr Clin Med Screening for SARS-CoV-2 Infection Within a Psychiatric Hospital and Considerations for Limiting Transmission Within Residential Psychiatric Facilities -Wyoming