Ensuring Safe and Effective Psychiatric Care in COVID-19 Alternate Care Sites

This article describes an innovative program to provide safe, evidence-based psychiatric care at the Baltimore Convention Center Field Hospital (BCCFH), set up for COVID-19 patients, to alleviate overextended hospitals.

This article describes the staffing and workflows utilized at the BCCFH including universal suicide risk assessment and co-management of high acuity patients by an NP-led psychiatry service.

The Columbia-Suicide Screening Rating Scale (C-SSRS) proved feasible as a suicide screening tool. Using the SAFE-T protocol, interdisciplinary teams cared for moderate and low risk patients. The NP psychiatry service evaluated over 70 patients, effecting medication changes in more than half and identified and transferred several decompensating patients for higher-level psychiatric care. Group therapy attendees demonstrated high participation. There were no assaults, self-harm incidents, or suicides.

The BCCFH psychiatry/mental health program, a potential model for other field hospitals, promotes evidence-based, integrated care. Emphasizing safety, including suicide risk, is crucial within alternate care sites during disasters. The engagement of dually-certified (psychiatric and medical) nurse practitioners boosts safety and provides expertise with advanced medication management and psychotherapeutic interventions. Similar future sites should be ready to handle chronically ill psychiatric patients, detect high-risk or deteriorating ones, and develop therapeutic programs for patient stabilization and support.