Potential Options for Least Restrictive Inpatient Care while under COVID-19 Isolation Precautions
| Care | Inpatient Setting Option | Considerations |
|---|---|---|
| Least restrictive | Setting: Discharge from psychiatry and transfer to medical unit Isolation: Individual is under COVID-19 isolation precautions Restrictions: Fewer restrictions of personal belongings, phone, TV, leisure activities, and visitation | For patients no longer under civil commitment, this is best option if psychiatric symptoms no longer interfering but no safe discharge option Only possible if connected to medical hospital and burden of COVID-19 cases low enough to allow this Option for either COVID-19 positive or exposed patients |
| Less restrictive | Setting: Transfer to designated COVID-positive inpatient psychiatric unit/bed Isolation: Entire unit or area is under COVID-19 isolation precautions, patients are cohorted Restrictions: Less strict isolation from peers as all are COVID-positive and able to move around more, and therefore may have more access to TV, phone, leisure activities | Depends on availability of these types of units within the area or healthcare system; may need to create these units when burden of COVID-19 in the community is high Not an option for COVID-exposed patients who are still negative but may convert to positive and cannot be cohorted as either negative or positive during quarantine |
| More restrictive | Setting: Continue admission on acute inpatient psychiatric inpatient unit Isolation: Individual is under strict COVID-19 isolation precautions Restrictions: alternate level or step-down psychiatric beds, with fewer restrictions of access to phone, Internet and personal belongings | May be challenging to create new rules for psychiatric units/beds when most units have strict policies for safety and are heavily regulated More challenging for units treating more acute, aggressive or violent patients who may gain access to this patient's belongings and become unsafe if on mixed acuity unit Very difficult to maintain and reinforce strict isolation precautions on an acute psychiatric unit |
| Most restrictive | Setting: Continue admission on acute inpatient psychiatric unit Isolation: Individual is under strict COVID-19 isolation precautions Restrictions: Typical unit restrictions, limited use of phone, may not have TV time if in shared space or access to any other shared leisure activities or Internet | May be only option if hospital system overwhelmed and at capacity on medical units, and if no COVID-positive psychiatric beds available, and if no other psychiatric units or limited resources or ability to impose fewer restrictions even for more stable patients Very difficult to maintain and reinforce strict isolation precautions on an acute psychiatric unit |