Background In January 2021 there was an outbreak of COVID-19 at a local mental health unit. This adult unit with 67 beds cared for multiple psychiatric conditions. The appropriate transfer to the acute hospital of ill patients and support for the psychiatric team in managing those patients not for escalation was required.

Aims To promote equality of access for psychiatric inpatients who became ill with COVID-19 to appropriate management including from acute medicine and from palliative care.

Readily available palliative care support to medical and psychiatric teams regarding symptom control.

To enable decisions to be made re appropriately not escalating care to the acute hospital with the security of timely access to palliative care support.

Methods Establishment of a virtual ward round (VWR) at a set time daily attended by the psychiatric team, an Acute medical consultant and consultant or SpR in palliative care. Inclusion criteria were agreed for which patients to bring to the VWR. A treatment escalation plan was discussed for each patient.

Results VWR ran daily for three weeks and alternate days for a further two weeks. Twenty-five patients aged 20-80 years were referred to the VWR with a range of psychiatric conditions and medical co-morbidities. Twenty-three of the 25 were judged appropriate for escalation of treatment. Eight of the 23 were admitted to the acute hospital, two of whom died. For the remaining two patients the decision was made not for escalation, care to continue at MHU.

Conclusion The VWR provided a clear and timely process for referral and discussion of symptomatic patients. Treatment escalation plans were made in collaboration with the psychiatric team who knew the patients well, together with the expertise of acute medicine in the context of support from the palliative care service should the MHT need to care for those at end-of-life.