Jeff Magill, Emergency Management Coordinator at UPMC Western Psychiatric Hospital discusses the extensive efforts underway to keep patients and staff safe during COVID-19. And discusses why patients shouldn’t delay seeking care.
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– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider.
The extensive work underway to keep patients and staff safe during COVID-19. Welcome to the UPMC HealthBeat Podcast. I’m Tonia Caruso, and joining us right now is Jeff Magill. He is the emergency management coordinator for UPMC Western Psychiatric Hospital. Thanks so much for joining us.
– Thank you, Tonia. It’s a pleasure to be with you today.
– So you actually have a few other titles and roles at Western as well. Tell me a little bit about those.
– Yeah, in addition to the manager for emergency preparedness at UPMC Western Psychiatric Hospital, I also oversee our Crisis Training Institute, where I serve also in a managerial role. And also, I oversee what we call our Critical Incident Stress Management: ASAP, or As Soon As Possible, staff support resource. Both of these programs were very instrumental during this response to COVID-19, thinking about preparing our employees from a crisis perspective, as we know stress levels are very high currently with our individuals in our care. And so escalation agitation is very real with a high level of acuity. So preparing our employees from a crisis training perspective is so vital and important. Additionally, you think about the needs of our health care members, specifically our staff at Western Psychiatric Hospital and across our UPMC Western Behavioral Health service line. Being there as a colleague support resource, helping them manage not only the impact of stress in the workplace but just how they’ve managed their response and their family’s response to COVID-19 personally. We’ve been very extremely busy, as you can imagine.
– You actually began to prepare for something like this long before COVID came to our region.
– One of the things that we know within emergency management is we have to try to forecast the future. We generally look at emergency management from an all-hazards approach, but one of the things that we did specifically in 2019 was look at the need for an emergent infectious disease plan, working very closely with the leadership across UPMC and more specifically the leadership within our service line of Behavioral Health, as well as our infection preventionists, and develop an emergent infectious disease plan for both the hospital and our vast array of services and programs and our service line, so that we can be prepared should we face a pandemic.
– The scope of services that Western Psychiatric Hospital provides is so vast, but let’s give folks a general sense of all the programs you had in front of you, the hospital you had in front of you, a sense of the scale that you had to prepare for.
– So at UPMC Western Psychiatric Hospital, we have about 250 inpatient psychiatric beds. But when you think about our service line as a whole, known as UPMC Western Behavioral Health, we encompass about approximately 500 inpatient psychiatric and detox beds, with approximately another four community mental health centers as well as approximately 70 ambulatory and community programming areas, including addiction medicine. It’s really important that folks understand, at UPMC Western Behavioral Health, we are a national leaders, and we’re on the cutting edge of treatment for mental health care as well as substance use treatment.
– How much more difficult did COVID-19 make treatment of patients?
– Yeah, it’s a great question. One of the things that’s unique, especially within our inpatient behavioral health service line is just the layout of our inpatient care setting. A lot of time in the medical environment, we have individualized rooms. And certainly at UPMC Western Psychiatric Hospital and other inpatient Behavioral Health service line areas, patients do have rooms, but they’re not always individualized. Sometimes they have a roommate, if you will. But most of the care, most of the treatment, most of the group interaction happens in a milieu-type setting. Certainly with a pandemic where we need to socially distance, it makes a unique challenge for us because individuals weren’t able just to go into the room and have that individual care. A lot of that still happened in a treatment modality type setting in a communal way. So we worked extremely close with our leadership, with our infection prevention team to make sure that we can properly deliver that care. This includes universal masking for both our patients and for our staff, making sure that we had good education for our patients as to why we mask and to understand that masking in itself can be a trigger for anxiety, for fear, for other traumas. And so we really had to engage our patients who are very acute at times around this importance in mask adherence, also while trying to find the best way to deliver group modalities with masking and with social distancing. So these were unique challenges, but I can’t say enough, again, speaking to staff resiliency, the staff took this straight on. They took it head-on, as did our leadership, and we really forged through this process. We had many individuals who were very reluctant to continue with on-site care, and so one of the big challenges that we were faced with initially was, how do we continue to deliver the great-quality, cutting-edge treatment that we’re known for virtually? And so very quickly, we were able to implement telehealth services, including our group-type programming, so that individuals in our community areas were not disconnected from their treatment team. We know folks work extremely hard for their recovery, and we couldn’t allow a pandemic to interfere with that.
– How important, though, too, for people to come back physically for care?
– Long-term, we really encourage our folks to come back to on-site care. We know it serves our population, our patients, and our community best when they’re in person with our treatment providers. We have never closed one program during this pandemic, and that’s something we are extremely proud of at UPMC Western Behavioral Health. So, to that point, coming back, being with your provider, knowing that, as an organization, we’re doing everything to keep not only our patients safe, our community safe, but our staff safe to be able to deliver that in-person care is so important. Some of the things that we’re doing to make sure that you’re safe when you come into our offices include social distancing, include cleaning of high-touch areas. At our hospital and our hospital-based clinics, we’re temperature scanning everybody who comes in, which includes our patients, our staff members, our support role visitors, if you will, and our vendors who access our hospital on a day-in and day-out basis.
– So can you talk a little bit about how even the visitor’s policy may have been impacted and what check-in looks like now?
– It was necessary to ensure individuals that would come into the hospital were screened properly, were masking universally, and that we were able to ensure that our screening process not only aligned with UPMC guidance but the local Allegheny County Health Department, the World Health Organization, and the Centers for Disease Control. There was a time early on where we had to restrict access to all visitors. And again, this was for the necessary steps to protect our employees as well as our patients. Over time, through the transition of phases within the COVID-19 response, we were able to have just one visitor or support role coming to our emergency room, which we call our psychiatric emergency service area, and so individuals were able to come and accompany their loved one to that area for the evaluation. But we did not have inpatient visitation. We did, though, still continue to recognize the importance of visitation, so we moved those virtually. Over the last couple months, we moved to an on-site or on-person support role. That happens at our facility Tuesdays, Thursdays, and Saturdays. And the other four days of the week, we do this virtually. We were also able to establish two pods within our hospital should we face individuals that are COVID-19 positive with acute behavioral health need, where their behavioral health needs outweigh the medical need, where caring for them in our inpatient behavioral health hospital at Western Psychiatric was necessary. We had two negative-pressure pods that were established so we can provide that care. We worked very closely with UPMC Presbyterian Hospital to provide symptomatic testing, and then we were able to work through our own processes within our hospital for asymptomatic testing, which we continue to this day.
– How successful have all of these measures been? What has been the level of cases that you have seen?
– And so this is something we’re extremely proud of. At the hospital itself, we’ve worked very closely with our leadership, with our infection prevention team, and our command center structure to really work hard to keep COVID-19 from entering our hospital. Because of the uniqueness that I spoke of, having a common treatment area, it’s important to make sure that when we had somebody that was symptomatic, we would isolate that individual immediately. One of the ways that we could do that
beyond the initial screen was we were taking temperatures of our patients throughout the day, sometimes as much as four times a day, so that we can detect early on any onset of a temperature. The moment that we noticed that, or there were other symptoms — cough, feeling feverish, body aches, sore throat, those kind of things — we would escalate that through our processes. It would often involve an advanced practice provider, our family medicine individuals, and being able then to communicate with the command center to isolate that individual and determine testing need. It’s so imperative because of the cohort approach to our care within our service line that we are able to isolate the person, get them treated through COVID-19 testing to detect whether or not it’s COVID that we were dealing with or some other underlying medical condition. We were extremely successful, and knowing that we’re still not out of the woods with this pandemic, we continue to monitor this very closely to ensure that we don’t have a COVID-19-positive patient within our hospital. And to this point, we have not.
– What would you like to say about the staff?
– The resiliency of our staff is remarkable. It’s amazing. We knew before this pandemic that we had probably the most compassionate, empathetic, caring individuals in health care located within UPMC Western Behavioral Health service line. This just affirmed that. Working through this pandemic, seeing folks and the sacrifices that they made to continue to be present for their patients in any way that was needed, whether that was in person or whether that was through telehealth, while all the time, they were still managing their own impact to COVID-19 in this pandemic, is just remarkable. Seeing folks make those sacrifices, dealing with the stress, the long hours, the uncertainty and the fear and the anxiety that this pandemic had, it reassured me that, from an emergency management perspective, we were doing everything right to reassure our staff and to create a safe environment. But the remarkability of our staff and the resiliency was just amazing.
– And so I know that this work will continue as we move forward. Is there a lesson, a big takeaway, that you would want to share with others?
– I think the biggest takeaway for us is always be in that state of readiness. We never know what’s going to be around the corner, but what we found in 2019 is we begin to plan for emergent infectious diseases. Early planning, careful consideration, engaging folks meaningfully for what might be on the horizon really sets us up as an organization to be the best we can be to keep our staff, our patients, and our community safe. The message is because of that preparedness, we are ready. We continue to stand ready, and because of that, we’re safe. It’s safe to come back to us. It’s safe to once again re-enter into our treatment areas, to our outpatient clinics, to our hospital-based clinics, and the inpatient service line. The biggest takeaway for us is that we are successful despite this horrific event known as COVID-19 pandemic, but that we stand ready for you.
– Jeff Magill, thank you so much for your time today. We certainly do appreciate it.
– Thank you so much. We appreciate you taking the time.
– I’m Tonia Caruso. Thank you for joining us. We hope you join us again on UPMC HealthBeat.
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UPMC Western Psychiatric Hospital is a nationally recognized leader in mental health clinical care, research, and education. It is one of the nation’s foremost university-based psychiatric care facilities through its integration with the Department of Psychiatry of the University of Pittsburgh School of Medicine. UPMC Western Psychiatric is the hub of UPMC Western Behavioral Health, a network of nearly 60 community-based programs providing specialized mental health and addiction care for children, adolescents, adults, and seniors throughout western Pennsylvania.