ABSTRACT
Background/Significance: Severe depression, psychosis, and catatonia are prevalent conditions on inpatient medical-surgical services and frequently drive psychiatric consultation. These syndromes are more common in patients with SMI, who are often socioeconomically disadvantaged. ECT can be a rate limiting and urgently indicated therapy in the treatment of these conditions. Transfer to inpatient psychiatry for the purposes of providing ECT can be difficult due to medical-surgical instability. ECT is at baseline a scarce resource in many institutions. Access to ECT for patients outside the inpatient psychiatric service is limited and requires the cooperation of multiple services. Barriers to the provision of ECT on the medical-surgical floors include navigation of a typically full ECT schedule, anesthesia availability, the portability of ECT equipment, and, more recently, restrictions imposed by the COVID-19 pandemic, which necessitates further precautions for procedures requiring anesthesia. We describe a quality improvement intervention designed to assess the needs for and delivery of urgent / emergent ECT referrals in the general hospital. Methods: We convened a group of stakeholders including representatives from medicine, surgery, anesthesia, nursing, and psychiatry to identify the current practices related to care of patients with neuropsychiatric illness who are medically and/or surgically unstable for transfer to inpatient psychiatry and who require urgent/emergent ECT. Goals of this project included education about prevalence, diagnosis, and associated morbidity of catatonia, the role of ECT in catatonia and related psychiatric conditions, and identification of barriers and solutions to providing timely access to ECT. Results: Stakeholders identified the emergent need for ECT and proposed either the creation of an on-call emergency ECT service akin to other on call services such as interventional radiology, dialysis, and surgical subspecialties, and/or the designation of a daily ECT emergency add-on slot. The barriers to intervention and proposed solutions were addressed by stakeholder group participants. Discussion: Neuropsychiatric conditions, including catatonia, can complicate and/or be driven by underlying medical-surgical illness. These patients can become too sick to transfer to inpatient psychiatry. More time on the medical and/or surgical units results in a positive feedback loop of worsening illness, further delaying transfer to inpatient psychiatry. By creating an on-call / designated add-on system for the provision of emergent ECT, we aim to reduce the overall morbidity associated with these conditions. Conclusion/Implications: Improving access to ECT services for medically-surgically ill patients with severe psychiatric comorbidities via an emergency ECT service allows for earlier treatment of these conditions and can improve patient outcomes. References: 1. Lloyd JR, Silverman ER, Kugler JL, Cooper JJ. Electroconvulsive Therapy for Patients with Catatonia: Current Perspectives. Neuropsychiatr Dis Treat. 2020;16:2191-2208. Published 2020 Sep 25. 2. Ramakrishnan VS, Kim YK, Yung W, Mayur P. ECT in the time of the COVID-19 pandemic. Australas Psychiatry. 2020;28(5):527-529.
ABSTRACT
During the COVID-19 pandemic, ensuring the gradual recovery of anesthesia nursing unit and avoiding cross-infection between surgical patients and staff are difficult problems for hospital managers. We outlined the emergency response measures and the transition to normal operation of the anesthesia nursing unit in West China Hospital, which is a large teaching hospital. This mainly included hospital and operating room channel management, three-level screening management of patients and medical staff, classification management of patients undergoing anesthesia and recovery, training management of medical personnel, strict environmental management, and online teaching management.