When the COVID-19 pandemic began in early 2020, it left the health care industry reeling among all specialties. Not only would health care workers be caring for their usual patients but also an influx of highly-infectious, COVID-19 patients. This put an added emphasis on keeping patients, physicians, and staff safe.
Physicians at the UTHealth Harris County Psychiatric Center (UTHealth HCPC), the largest provider of inpatient psychiatric care in the Greater Houston area, faced the added challenge of safely caring for patients who not only may be positive for COVID-19 but also may be simultaneously facing serious psychological issues. Often times, psychiatric patients cannot or do not consent to testing because of a severe mental illness, while certain patients with severe mental illness may lack the ability to follow safe guidelines, such as mask wearing or social distancing.
“When COVID-19 began, we were left with the question of how to manage a highly infectious virus in a freestanding psychiatric hospital,” said Lokesh Shahani, MD, MPH, assistant professor in the Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences and chief medical officer at UTHealth HCPC. “There was no existing published guideline on how to do this.”
HCPC created an isolated COVID-19 unit to ensure patients facing psychiatric crisis received the proper care throughout the pandemic and to continue to see as many patients as possible while keeping them out of general medical hospitals who would need beds during a surge.,. The unit served to provide safe isolation of COVID-19 positive patients, while still allowing access to the care they needed.
“We knew that a surge was coming and hospital beds at our hospitals throughout the Texas Medical Center would be at capacity,” Shahani said. “When that happened, we didn’t want patients with mental illness being admitted to a medical hospital just because we would not be able to accept the patient.”
HCPC dedicated a full unit in the hospital as a COVID isolation unit, where confirmed or suspected COVID-19 positive patients could be separated from patients who were negative for the virus and were in a general unit in the hospital.
The unit consisted of multiple collaborations around the school community, including the coordination to ensure staff had access to adequate personal protective equipment (or PPE) thanks to Cynthia Crespo-Bonaparte, MS, safety manager at UTHealth and Tim Burr, director of business operations at HCPC. The HCPC also collaborated with Gustavo Ayala, MD, professor and vice chair for outreach in the Department of Pathology and Laboratory Medicine, to arrange for the testing of suspected COVID-positive patients and Luis Ostrosky, MD, professor of infectious diseases and vice chair of Healthcare Quality, to ensure proper safety protocols. Deborah Parker, infection control practitioner at UTHealth HCPC, assisted Shahani, in implementing infection control practices throughout the hospital.
With a plan for care in place, the HCPC began searching for nurses and staff who were willing to volunteer to help treat patients in the COVID unit, which they planned to staff day-and-night. Since infection control is not usually an area psychiatric nurses handle, they required proper training on how to use the PPE appropriately and how to keep themselves and the patient safe throughout treatment.
“Using PPE is not something that is part of the routine process for nurses at our psychiatric hospital, so we made sure we didn’t force someone to work on the unit,” Shahani said. “These are all volunteers, and I’m so proud of all the nursing staff who signed up and showed this dedication on the COVID-19 side and said, ‘We’re going to be there and take care of those patients.’ That was a huge success. We are also so grateful to our admissions department who ensure the patient admission workflow was never disrupted throughout the pandemic.”
HCPC admitted its first suspected positive patient with COVID-19 in mid-April of 2020. In the nine months that have followed, they have safely treated approximately 180 suspected positive patients, with more than 100 actually being confirmed COVID-19 positive patients.
“We published some of our findings in Psychiatry Research and our experience coordinating the unit,” Shahani said. “Those findings have been nationally acknowledged and now are being used as a model in various hospitals throughout the state in order to implement infection control policies in their buildings.”