Adult Psychiatric COVID Cohort Unit

In April 2020, CMC Psychiatry leaders identified the need to create a COVID-19 cohort unit for patients in the Cleveland area. This unit offers patients with a primary psychiatric diagnosis and a secondary COVID diagnosis to have a location for psychiatric stabilization and treatment.

The leaders began planning the physical layout and defining the type of services available. The unit started as a 19-bed unit, where temporary walling was put into place, allowing patients to freely move around in an area that would not expose non-COVID people.

Although recreational group programming was not initially offered, 1-to-1 over the phone and activity bags were utilized to maintain this part of the treatment plan. In addition, patients were also provided iPads, portable DVD players, radios and extra cordless telephones, which allowed the patients to enjoy some entertainment while in the cohort.

Over the almost two years that the cohort unit has been open, the staff has cared for 322 patients. Also, the unit has increased and decreased in size during this time. At times, there were only 6 COVID beds, others times 12, and at its capacity, 19. The staff has shown great resilience and adaptation in the uncertain times of the COVID-19 pandemic.

Before the unit opening, the team partnered with the Infection Prevention Nurse, who came on to the unit, demonstrated the proper technique for donning and doffing PPE, answered questions from staff, and prepared the team for what things would look like moving forward. The IP Nurse has been consulting the team as needed throughout the pandemic.

Several new Standard Operating Procedures had to be put into place to reflect the changes in how the unit would function; these ranged from admission and discharge practices to daily safety huddles. In addition, the providers and infection prevention worked to put into place medical parameters to determine what conditions and symptoms were safe to manage in a psychiatric unit.

Security was another department that we worked very closely with, as we had to put Standard Operating Procedures into place for emergencies and Code Violets. Extra cameras were installed in a few patient rooms for 1:1 monitoring not to expose staff for long periods. When in use, the staff members are in full PPE in the COVID hallway monitoring the cameras via laptop. When the cameras are not in use, security turns them off.

Currently, the unit is at 12 beds, but as the COVID numbers are on the decline, we look to decrease the unit to 6 beds, which may be the new normal.