The Impact of Integrating Palliative Medicine Into COVID-19 Critical Care

Erica Schockett; Mary Ishola; Taylor Wahrenbrock; Annabelle Croskey; Shannon Cain; Ivy Benjenk; Danielle Davison; David Yamane

doi:10.1016/j.jpainsymman.2020.12.014

The Impact of Integrating Palliative Medicine Into COVID-19 Critical Care

J Pain Symptom Manage. 2021 Jul;62(1):153-158.e1. doi: 10.1016/j.jpainsymman.2020.12.014. Epub 2021 Feb 9.

Authors

Erica Schockett¹, Mary Ishola², Taylor Wahrenbrock², Annabelle Croskey², Shannon Cain², Ivy Benjenk³, Danielle Davison⁴, David Yamane⁵

Affiliations

¹ Assistant Professor, Department of Internal Medicine, The George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA. Electronic address: eschockett@mfa.gwu.edu.
² The George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA.
³ Research Coordinator, Department of Anesthesia and Critical Care Medicine, The George Washington University, Washington, District of Columbia, USA.
⁴ Associate Professor, Department of Anesthesia and Critical Care Medicine, Associate Professor, Department of Internal Medicine, The George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA.
⁵ Assistant Professor, Department of Emergency Medicine, Department of Anesthesia and Critical Care Medicine, The George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA.

Abstract

Background: Ensuring high-quality patient-centered care for critically ill coronavirus disease 2019 (COVID-19) patients presents unprecedented challenges. Many patients become critically ill unexpectedly and have not previously discussed their health-care wishes. Clinicians lack experience with this illness and therefore struggle to predict patient outcomes.

Measures: Critical care medicine (CCM) providers were surveyed about the effectiveness and efficiency of a pilot intervention.

Intervention: Proactive palliative care rounding with CCM providers on COVID-19 intensive care units.

Outcomes: Fifty-four percent of CCM providers responded to the survey (21/39). CCM providers rated the intervention highly across all domains. CCM providers frequently identified that early palliative involvement was critical to providing families with information and support when separated from their loved ones.

Conclusions/lessons learned: This pilot study found that proactive rounding improves critical care provider assessments of quality of care for patients and families and allows CCM providers to focus their efforts on managing complex physiology and surges.

Keywords: COVID-19; Consult identification; Early palliative; Proactive rounding; Serious illness communication.

MeSH terms

COVID-19*
Critical Care
Critical Illness / therapy
Humans
Palliative Care
Palliative Medicine*
Pilot Projects
SARS-CoV-2