Objectives
- 1.Describe an approach to obtaining early palliative care consultation in an acute care setting.
- 2.Describe interventions to address goals of care during a pandemic.
Background
COVID-19 is a pandemic with approximately 20% of patients infected requiring hospitalization, and 50% of patients experiencing disease progression to ARDS do not survive. Dying in the hospital is associated with more suffering, and during a pandemic carries additional distress due to rapid decline requiring urgent conversations about escalation of care during social isolation. Our community hospital has 197-beds, including 36-bed ICU, with a dedicated Palliative Care Advance Practice Nurse (APN) service. In collaboration with physicians, Palliative Care APNs developed a strategy to provide early palliative care consultation to every COVID-19 patient under investigation (PUI).
Aim Statement
The purpose was to determine the impact of early palliative care consultation in the hospital.
Methods
Obtaining palliative care consultation involved rounding on COVID units and requesting goals of care consults on all PUIs. Consultation included identifying decision-makers, counseling on medical condition, CPR and intubation, goals of care, escalation of care, and transition to comfort care when appropriate. Outcomes measures from existing reports were reviewed for all patients from March 1, 2020, to May 31, 2020.
Results
There were 394 Palliative Care consults between March and May of 2020. 63 patients were not seen due to staffing and 25 patients were not included due to provider request not to address goals of care. Consultation resulted in establishing a decision-maker in 345 patients (98.2%) and 137 patients (45%) changed their code status. After meeting with palliative care, 131 patients (44.2%) changed their goals of care and one-fourth (75 patients, 25.5%) transitioned to comfort care. Fifty-three patients (17.7%) died in the hospital and thirty-nine patients (12.9%) discharged with hospice.
Conclusions and Implications
Due to the rapid decline associated with COVID-19, early palliative care consultation is key to providing patients and families with an opportunity to discuss their wishes for care to avoid unnecessary suffering, and to better utilize resources to prevent further stress on the healthcare system.
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Copyright
© 2021 Published by Elsevier Inc.
