(035) Improving Patient Care Transfers to a New COVID-19+ Behavioral Health Unit During the Omicron Surge

Abstract: Background/Significance: Inpatient CLP teams spend significant amounts of time facilitating transfers of medically stable, general hospital patients in crisis to inpatient psychiatric beds. This process has been complicated by the COVID-19 pandemic, especially with the limited ability of psychiatric hospitals to care for patients with asymptomatic COVID-19 infection. When our institution opened a new COVID+ psychiatric unit during the 2022 omicron surge, new eligibility screening and improved handoff communications were needed to ensure appropriate and timely intrahospital transfers.

Methods: Since 2020, asymptomatic COVID+ patients in behavioral health crisis were quarantined on general hospital units at our institution. We iteratively changed the process and handoff tool by which we collate and communicate the list of patients seeking inpatient psychiatric care. Through collaboration with our social work, nursing, and physician leadership teams, this information supported the need for creating a COVID+ unit in our medical center’s psychiatric hospital. Consultation interventions, screening procedures, and electronic handoffs were modified to emphasize details about COVID infection and quarantine status, medical risk profile, and transfer eligibility to match the new unit eligibility requirements.

Results: Improved patient tracking and transfer communication workflows allowed COVID+ patients meeting specific medical stability criteria to transfer to the psychiatric COVID+ unit prior to completion of the full quarantine period. The number of patients boarding in the general hospital while awaiting psychiatric inpatient care fluctuated during our study period. This number increased significantly, commensurate with the timeframe of the COVID-19 Omicron surge. This increase was largely driven by patients with asymptomatic COVID-19 infection. Barriers included uncertainty about epidemiological procedures, and necessity of tracking and reporting a frequently changing set of data.

Discussion: Our model demonstrated operational thresholds seen in patient flow data to support optimal timing for opening a COVID-19 isolation capable unit. This process can support administrative decisions about unit epidemiologic modifications during future community infection surges. Standardized flow tracking and communication models can be adapted to rapidly changing infection control requirements, and can be operationalized by clinical teams with rotating trainees with minimal additional training.

Conclusions/Implications: Specific criteria for admission to a new COVID+ unit were created and disseminated, with updated transfer data being distributed daily. Updated training for rotating team members providing bedside care is ongoing. QI methodology and statistical process control measures can be applied to consultation patient workflows in a manner that can signal the need to reorganize hospital units to better serve specific needs.

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   Scott AM, et al. Understanding facilitators and barriers to care transitions: Insights from Project ACHIEVE site visits. The Joint Commission Journal on Quality and Patient Safety, 2017;43(9)433-447.
   
   


2. 
   Bojdani E, et al. COVID-19 Pandemic: Impact on psychiatric care in the United States. Psychiatry Res. 2020 Jul;289:113069.