Addressing Palliative Care Needs of COVID-19 Patients in New Orleans, LA: A Team-Based Reflective Analysis

Rebecca V Burke; Robin Rome; Kelly Constanza; Malaika Amedee; Charles Santos; Alexandra Leigh

doi:10.1089/pmr.2020.0057

Addressing Palliative Care Needs of COVID-19 Patients in New Orleans, LA: A Team-Based Reflective Analysis

Palliat Med Rep. 2020 Jul 22;1(1):124-128. doi: 10.1089/pmr.2020.0057. eCollection 2020.

Authors

Rebecca V Burke^{1

2}, Robin Rome¹, Kelly Constanza¹, Malaika Amedee¹, Charles Santos¹, Alexandra Leigh^{1

2}

Affiliations

¹ Section of Geriatrics and Extended Care, Southeast Louisiana Veterans Health Care System (SLVHCS), New Orleans, Louisiana, USA.
² Department of Internal Medicine, Tulane School of Medicine, New Orleans, Louisiana, USA.

Abstract

Background: New Orleans, Louisiana served as a central location for a surge of novel coronavirus cases during the months of March 2020 to May 2020. To provide guidance to palliative care teams naive to the palliative care demand associated with a surge of coronavirus cases, we document our protocol to best optimize palliative care resources. This report aims to present this information and reflect upon what was most beneficial/least beneficial to serve as a roadmap for palliative teams facing this pandemic. Objective: To pilot a team-based structured protocol to categorize severity of COVID-19 intensive care unit (ICU) admissions and subsequently collaborate with the palliative interdisciplinary team to assess physical, spiritual, and psychosocial needs. Design: New ICU consults were categorized into color-coded clinical severity "pots" during daily ICU interdisciplinary rounds. Clinical decision making and communication with patient/next of kin were based on "pot" classification. Settings/Subjects: Palliative medicine consults were placed on all COVID-19 positive patients admitted to the ICU between March 29, 2020, and May 1, 2020. Measurements: A retrospective chart review was performed to analyze the effect of palliative care consultation on completion of goals-of-care conversations and the life-sustaining treatment (LST) document, an advance directive form specific to the Veterans Affairs hospital system between March 29, 2020 and May 1, 2020. Results: Of the palliative consults evaluated by a palliative provider, 74% resulted in completion of a LST document, 58% resulted in video contact with family members, and 100% incorporated a goals-of-care discussion. Conclusions: We found that standardizing palliative care consultation on all COVID-19 positive ICU admissions subjectively alleviated the burden on ICU providers and staff in the midst of a crisis, resulted in increased documentation of patient goals-of-care preferences/LSTs, facilitated clinical updates to family members, and better distributed clinical burden among palliative team members.

Keywords: COVID-19; intensive care unit/intensive care unit issues in palliative care; palliative social work; palliative team.