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 Table of Contents  
EDITORIAL
Year : 2020  |  Volume : 36  |  Issue : 5  |  Page : 9-10

Patient support services for COVID-19 patients


Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

Date of Submission16-Sep-2020
Date of Acceptance16-Sep-2020
Date of Web Publication02-Oct-2020

Correspondence Address:
Dr. Abhijit R Rozatkar
Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_324_20

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How to cite this article:
Rozatkar AR. Patient support services for COVID-19 patients. Indian J Soc Psychiatry 2020;36, Suppl S1:9-10

How to cite this URL:
Rozatkar AR. Patient support services for COVID-19 patients. Indian J Soc Psychiatry [serial online] 2020 [cited 2020 Dec 1];36, Suppl S1:9-10. Available from: https://www.indjsp.org/text.asp?2020/36/5/9/297169



Since the onset of this pandemic, the All India Institute of Medical Sciences, Bhopal, has been functioning for COVID-19 services by providing emergency services (including operative care) with curtailed outpatient and inpatient services. More than 250 beds had been earmarked for COVID-19 patients, which are currently fully occupied. Apart from medical symptoms of COVID-19, patients diagnosed with COVID-19 experience significant psychological distress in the form of anxiety, low mood, guilt, biological dysfunction, and other symptoms. For some, these symptoms breach the diagnostic threshold for adjustment disorder, depressive episode, or bereavement. Hence, mental health assessment and intervention for all patients was necessary. However, with an admission rate of about 100 patients per week and limited workforce, this was a challenging task.

By the late April 2020, we were more than encouraged to don the personal protective equipment (PPE) kit and participate in ward rounds in the COVID-19 area. But as a caution, we chose to first check the feasibility of such a liaison. We found that most patients had anxiety symptoms because of the unclear course and outcome of their disease and the implications of their untoward outcome on their family members. The experience of being rounded up by police and health authorities from their home was particularly reported as embarrassing. During their stay in hospital, some patients developed the unusual concept of their fellow patients being more infective, thereby hampering the recovery of others. This followed the unusual request to reallocate beds elsewhere, to sanitize washrooms after use, to sanitize common utility items such as microwave, etc., From our perspective, we found that interacting with patients in PPE was uncomfortable, as it was difficult for the clinician to speak, vision was frequently affected due to fogging, and multiple long assessments were impossible. This feasibility assessment exercise led onto interesting developments and insights, but space constraints preclude further discussion. Hence, the culmination product, “Patient Support Services” (PSS) is being presented.

Our volunteer-driven PSS consists of two arms. The first arm is the patient interaction arm where volunteers interact with the inpatients telephonically. Our volunteers include one psychologist, four psychiatry residents, three nonpsychiatry faculty, 15 residents from the department of pharmacology, 12 nurses from the department of psychiatry, and one health educator. All volunteers are trained to identify issues commonly reported by the COVID-19 patients. Volunteers call from their personal mobile phone, and because patients now have their number, they can call back anytime should any need arise. Newly admitted patients are allocated to these volunteers on a daily basis and they call all their patients every day until discharge. If any nonpsychiatry volunteer is unable to handle patients' issues, the case is transferred to the psychologist/psychiatrist, who deals with them through video calling. We have conducted counseling sessions, anxiety management sessions, relaxation techniques, etc., on video consultations. For patients in the intensive care unit (ICU), volunteers would contact their family members.

The second arm is communication of patients' issues to appropriate authorities. This is done through a WhatsApp group. This group includes consultants of department of general medicine (acute respiratory infection ward), consultants managing the ICU (acute respiratory infection ICU), medical social workers, dieticians, and representatives of the medical superintendent. Volunteers inform of patients' issues in this group in a set format (who has the issue, what is the issue, and who can deal with the issue). In turn, clinicians from the ward and ICU apprise volunteers of the clinical status of patients on a daily basis. This is possible as each ward has a large bulletin board where patients' name, clinical condition, dietary requirements, current medications, and latest reverse transcriptase polymerase chain reaction (RT-PCR) reports and testing schedule are displayed and updated 12 hourly. A photograph of this board is posted in the WhatsApp group, which enables the volunteers to be abreast of their patients' clinical condition. With this arrangement, the volunteers have been able to apprise clinicians of new symptoms of their patients and administration of ward issues such as cleanliness of ward and breakage of fixtures; social workers for issues such as need of ambulance and need for medications; dieticians of special meal requests, food quality, etc.; and family members of ICU patients of their status.

Volunteers, who additionally continue to perform their regular role in their respective department, are the keystone of this model. They address patients' concerns to the best of their ability, escalate them if required, and communicate back to the patient. Patients have 24 × 7 access to them and through them to all people concerned with their care. Indeed, there have been situations which could have falsely discredited the institute but were handled efficiently by our volunteers. A structured evaluation of PSS in future should affirm our observations. Nevertheless, PSS' is a unique service delivery model in managing COVID-19 inpatients for preventing clinical, communication, and (media) reporting mishaps.






 

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