key: cord-1025558-lypp7l8k
authors: Kanellopoulos, Dora; Castellano, Christina Bueno; McGlynn, Lauren; Gerber, Sheera; Francois, Dimitry; Rosenblum, Lauren; Runge, Marisol; Sanchez-Barranco, Pablo; Alexopoulos, George S.
title: Implementation of telehealth services for inpatient psychiatric Covid-19 positive patients: A blueprint for adapting the milieu
date: 2020-09-10
journal: Gen Hosp Psychiatry
DOI: 10.1016/j.genhosppsych.2020.08.011
sha: bfb5e9d62aa75a2c1d97622ee81bdb66f3dc9c7e
doc_id: 1025558
cord_uid: lypp7l8k

nan

mental health care (Telemental Health ) [3] protocol to:1) maintain multidisciplinary treatment delivery despite isolation protocols; 2) promote patient support by family and friends during a time of in-person visitor restrictions, and reduce the risk of COVID-19 cross-contamination during in-person contact. Here we describe in brief the benefits and challenges of our inpatient Telemental Health conversion (See Appendix 1 for detailed information).

Prior to admitting only COVID-19 positive patients, our unit had a capacity of 17 beds, with most rooms housing one patient per room. Patients received daily assessment by a psychiatrist, individual psychotherapy, several group therapy and activity sessions, and met with nursing staff and non-psychiatric physicians, physical therapists, pharmacists, chaplains, as needed throughout the day. After the COVID-19 conversion, the census was limited to 15 patients, so that each patient had an individual room; two rooms were used for donning and doffing personal protective equipment (PPEs). To mitigate viral spread, patients had to remain in their room with the door closed and only had in-person interactions with the treatment staff for medication dispensing, vital signs, blood drawing, and room checks. [4] Initially, patients communicated with staff and family via portable landline telephones, therapy groups were suspended, and PPE including masks, gowns, and face shields made inperson interactions difficult. We quickly realized, while these procedures limited the risk of contamination, they led to patient isolation with the potential to interfere with treatment progress.

Within two weeks, we planned implemented our protocol for inpatient Telemental Health delivered mainly though tablets provided by our hospital. We selected a core team consisting of a clinical psychologist and a clinical social worker to design and lead our Telemental Health conversion program and manage program logistics including training hospital staff on-site. All program documentation was stored in a secured server-based folder accessible to clinical staff. While rapidly designed out of necessity, the implementation of Telemental Health followed an iterative process of improvement [5]. Our paramount concern was patient safety. In response, we implemented daily risk and safety screenings before patients were given a tablet (Appendix 2: Tablet Risk Screening). Another concern had been the patients' ability to navigate technology. Psychopathology, cognitive impairment, and limited prior familiarity with technology were potential barriers to use. To address these issues patients received verbal and written instructions to orient them to tablet functions.

We were particularly sensitive to protecting patient privacy. Initially, we created "dummy" email addresses that anonymous use by patients. However, we were forced to abandon this approach because the high volume of COVID-19 positive admissions places a heavy demand on staff time. The hospital's Information Technology Department purchased several hundred temporary email addresses from a large corporation for patient use. These email addresses were used to access telecommunications software and were kept in a "directory" on our secured server so that staff could contact patients directly. At discharge, patient temporary email addresses were retired, and the tablet was reset to factory settings, deleting all personal user information. A new temporary email address was assigned to the next admitted inpatient. Disinfection and charging of tablets were also challenging. Each night, we collected all tablets from the patients, disinfected, charged and returned them to the patients on the next morning

The Telemental Health conversion of our inpatient psychiatric COVID-19 positive unit was supported by funding from our hospital system. Although investing in technology to support J o u r n a l P r e -p r o o f Journal Pre-proof inpatient psychiatric treatment is costly, containing the spread of COVID-19 while offering highquality psychiatric care to address psychiatric symptoms is imperative and could prevent larger long-term healthcare costs. Our inpatient Telemental Health protocol can be modified and used with a variety of different hardware and software to fit the needs of smaller institutions during these challenging times.

Rapid Response to COVID-19: Health Informatics Support for Outbreak Management in an Academic Health System

Worker Perspectives on Contemporary Milieu Therapy: A Cross-Site Ethnographic Study

Practice guidelines for videoconferencing based Telemental Health. American Telemedicine Association

A COVID-19 testing and triage algorithm for psychiatric units: One hospital's response to the New York region's pandemic

We would like to acknowledge the efforts of all NYP "Haven" Unit Staff as well as information technology services and the leadership of our hospital who made this project a priority in the service of providing care for our patients.