Adaptations made to pediatric consultation-liaison psychiatry service delivery during the early months of the COVID-19 pandemic: A North American multi-site survey

Brahmbhatt, Khyati; Mournet, Annabelle M.; Malas, Nasuh; DeSouza, Claire; Greenblatt, Jeanne; Afzal, Khalid I.; Giles, Lisa L.; Charoensook, Janet; Feuer, Vera; Raza, Haniya; Mooneyham, GenaLynne C.; Pergjika, Alba; Schlesinger, Amanda; Chapman, Andrea; Strain, Angela; Gandhi, Bela; Johnson, Kyle; Mroczkowski, Megan M.; Ibeziako, Patricia; Graham, Regina; Yoon, Yesie; Plioplys, Sigita; Fuchs, Catherine; Shaw, Richard J.; Pao, Maryland

BACKGROUND: The COVID-19 pandemic led to rapid changes in clinical service delivery across hospital systems nationally. Local realities and resources were key driving factors impacting workflow changes, including for pediatric consultation-liaison psychiatry service (PCLPS) providers. OBJECTIVE: This study aims to describe the early changes implemented by 22 PCLPSs from the US and Canada during the COVID-19 pandemic. Understanding similarities and differences in adaptations made to PCLPS care delivery can inform best practices and future models of care. METHODS: A 20-point survey relating to PCLPS changes during the COVID-19 pandemic was sent to professional listservs. Baseline hospital demographics, hospital and PCLPS workflow changes, and PCLPS experience were collected from March 20, 2020 – April 28, 2020 and August 18, 2020 – September 10, 2020. Qualitative data were collected from responding sites. An exploratory thematic analysis approach was used to analyze the qualitative data that was not dependent on pre-determined coding themes. Descriptive statistics were calculated using Microsoft Excel. RESULTS: 22 academic hospitals in the US and Canada responded to the survey, with an average of 303 beds/hospital. Most respondents (18/22) were children’s hospitals. Despite differences in regional impact of COVID-19 and resource availability, there was significant overlap in respondent experiences. Restricted visitation to one caregiver, use of virtual rounding, ongoing trainee involvement, and an overall low number of COVID-positive pediatric patients were common. While there was variability in PCLPS care delivery occurring virtually versus in person, all respondents maintained some level of on-site presence. Technological limitations and pediatric provider preference led to increased on-site presence. CONCLUSIONS: To our knowledge, this is the first multi-center study exploring pandemic-related PCLPS changes in North America. Findings of this study demonstrate that PCLPSs rapidly adapted to COVID-19 realities. Common themes emerged that may serve as a model for future practice. However, important gaps in understanding their effectiveness and acceptability need to be addressed. This multi-site survey highlights the importance of establishing consensus through national professional organizations to inform provider and hospital practices.