QUALITY IMPROVEMENT: ESTABLISHING A SUSTAINABLE COVID-19 BEHAVIORAL HEALTH CARE UNIT

Due to the increased number of hospitalizations linked to COVID-19 infections, three of NewYork-Presbyterian's inpatient psychiatric units were converted into ICU units. Because many psychiatric patients required both medical and psychiatric care, leadership at Gracie Square teamed up with NewYork-Presbyterian enterprise to dedicate their units to COVID-19 psychiatric patients. A SUSTAINABLE BEHAVIORAL HEALTH CARE UNIT Gracie Square leaders knew that with effective management, a team approach, and precise planning, they could minimize the healthcare crisis's adverse effects. During the implementation phase, leaders identified and categorized some of the problems they would face, such as delay or lack of accurate and timely information, staff shortages, psychological reactions, and equipment shortage, all of which could lead to a failed project and increased mortality. Managing medical and psychiatric emergencies concurrently was difficult;system-wide meetings of Gracie Square senior leaders and other psychiatric facilities of NewYorkPresbyterian Hospital three times a week meant a constant change of COVID-19 protocols for identifying high-risk patients and setting guidelines for how often vitals and pulse oximetry were measured.

The Interface of COVID-19 and Inpatient Psychiatry: Our Experience and Lessons Learned.

The coronavirus disease 2019 (COVID-19) pandemic presented unprecedented challenges to the provision of inpatient psychiatric care. The nature of the physical plant, programmatic constraints, and the patient population required a rapid and agile approach to problem-solving under conditions of uncertainty and stress. Flexibility in decision-making, excellent communication, an effective working relationship with infection prevention and control experts, and attention to staff morale and support were important elements of successful provision of care to our inpatients. We present our experience, lessons learned, and recommendations should a resurgence of the pandemic or a similar crisis occur.

Inpatient psychiatry unit devoted to COVID-19 patients.

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.