(PO-166) (PO-166) A Comparative Review of COVID-19's Impact on Involuntary Hospitalizations in King County, Washington

The COVID-19 pandemic has undoubtedly changed the way we care for our patients, bringing about both positive innovations and exacerbating long-standing inequities in our most vulnerable patients. While the care of patients on the inpatient psychiatry setting has required difficult adaptions to curb the spread of the pandemic, (Bojdani et al 2020) the pandemic’s effect on the wait time to transfer to inpatient psychiatry has not been extensively reported. Here we describe the effect of the COVID-19 pandemic on the wait time for involuntary psychiatric hospitalization in King County, Washington. 
 
The first confirmed cases of COVID-19 in the United States were initially reported in King County, Washington. Like medical facilities across the United States and the world, medical facilities in King County were required to adapt with respect to screening and medical clearance of patient’s detained and waiting for inpatient psychiatric placement. The State of Washington imposed some of the earliest, and subjectively broadest restrictions and re-opening criteria related to the COVID-19 pandemic, which included hospitals. Unlike many states, the State of Washington directs that involuntary psychiatric admissions be facilitated and administered not by a physician, but by a Designated Crisis Responder (DCR), organized by county. Providers identifying a patient that requires involuntary hospitalization first place a referral to the appropriate local Designated Crisis Responder. If the responder agrees with the referral, the patient is detained. The State of Washington also requires that no patient can be held at a facility that is not a designated Evaluation and Treatment Center (E&T). Due to significant community capacity constraints at the designated E&Ts, Washington’s two public psychiatric facilitates – Eastern and Western State Hospitals – designate beds at various hospitals as “Single Bed Certification” beds, or SBCs. (RCW 71.05 and WAC 388-865). SBC data is publicly provided by the county. 
 
Our team decided to review the reported data regarding the number, and length of stay for SBCs in King County for the twelve-month period of 2020 following the declaration of a pandemic and imposition of subsequent restrictions and compare this to data from the previous twelve-month period of 2019 and observed no change in terms of patients waiting for involuntary care or the average time spent waiting in King County, Washington. The data will be presented and discussed in the context of providing timely and appropriate care to involuntary psychiatric patients. 
 
1. Bojdani E, Rajagopalan A, Chen A, Gearin P, Olcott W, Shankar V, Cloutier A, Solomon H, Naqvi NZ, Batty N, Festin FED, Tahera D, Chang G, DeLisi LE: COVID-19 Pandemic: Impact on psychiatric care in the United States. Psychiatry Research 2020; 289: 113069. 
2. Revised Code of Washington 71.05 
3. Washington Administrative Code 388-865