Abstract
New York City's first case of SARS-associated coronavirus (SARS-CoV-2) disease 2019 (COVID-19) was identified on 1 March 2020, prompting rapid restructuring of hospital-based services to accommodate the increasing numbers of medical admissions. Non-essential services were eliminated but in-patient treatment of psychiatric illnesses was necessarily maintained. To detail the response of the NYU Langone Health in-patient psychiatric services to the COVID-19 outbreak from 1 March to 1 May 2020. Process improvement/quality improvement study. Over this time period, our two in-patient psychiatric units (57 total beds) treated 238 patients, including COVID-19-positive and -negative individuals. Testing for COVID-19 was initially limited to symptomatic patients but expanded over the 62-day time frame. In total, 122 SARS-CoV-2 polymerase chain reaction (PCR) tests were performed in 98 patients. We observed an overall rate of COVID-19 infection of 15.6% in the patients who were tested, with an asymptomatic positive rate of 13.7%. Although phased roll-out of testing impaired the ability to fully track on-unit transmission of COVID-19, 3% of cases were clearly identified as results of on-unit transmission. Our experience indicates that, with appropriate precautions, patients in need of in-patient psychiatric admission who have COVID-19 can be safely managed. We provide suggested guidelines for COVID-19 management on in-patient psychiatric units which incorporate our own experiences as well as published recommendations.
Highlights
New York City’s first case of SARS-associated coronavirus (SARSCoV-2) disease 2019 (COVID-19) was identified on 1 March 2020, prompting rapid restructuring of hospital-based services to accommodate the increasing numbers of medical admissions
122 SARS-CoV-2 polymerase chain reaction (PCR) tests were performed in 98 patients
We observed an overall rate of COVID-19 infection of 15.6% in the patients who were tested, with an asymptomatic positive rate of 13.7%
Summary
The in-patient psychiatric services of NYU Langone Health started to change their approach to in-patient treatment in response to the COVID-19 pandemic in the first week of March 2020. (a) Initially, the number of visitors was reduced to one per patient, with visitors screened for temperature and infectious symptoms in the hospital lobby before entering the unit, per hospital protocol. No visitors were allowed on the in-patient psychiatry units, to reduce transmission. (d) Group therapies were initially attempted with social distancing; this proved impractical and face-to-face group therapy was eliminated after 2 weeks. Represents the proportion of known COVID-19-positive patients treated during this period (n = 13 on LB5900; n = 4 on HCC-10). Before 6 April 2020, not all patients received a COVID-19 test
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