Proactive Identification of Palliative Care Needs Among Patients With COVID-19 in the ICU

Laura A Schoenherr; Allyson Cook; Sarah Peck; Jessica Humphreys; Yuika Goto; Naomi T Saks; Lindsey Huddleston; Giovanni Elia; Steven Z Pantilat

doi:10.1016/j.jpainsymman.2020.06.008

Proactive Identification of Palliative Care Needs Among Patients With COVID-19 in the ICU

J Pain Symptom Manage. 2020 Sep;60(3):e17-e21. doi: 10.1016/j.jpainsymman.2020.06.008. Epub 2020 Jun 14.

Authors

Laura A Schoenherr¹, Allyson Cook², Sarah Peck³, Jessica Humphreys⁴, Yuika Goto⁴, Naomi T Saks⁴, Lindsey Huddleston⁵, Giovanni Elia⁴, Steven Z Pantilat⁴

Affiliations

¹ Division of Palliative Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA. Electronic address: laura.schoenherr@ucsf.edu.
² Division of Palliative Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA; Division of Critical Care Medicine, Department of Anesthesia, University of California, San Francisco (UCSF), San Francisco, California, USA.
³ Division of Palliative Medicine, Department of Social Work, University of California, San Francisco (UCSF), San Francisco, California, USA.
⁴ Division of Palliative Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA.
⁵ Division of Critical Care Medicine, Department of Anesthesia, University of California, San Francisco (UCSF), San Francisco, California, USA.

Abstract

In the setting of the coronavirus disease 2019 (COVID-19) pandemic, new strategies are needed to address the unique and significant palliative care (PC) needs of patients with COVID-19 and their families, particularly when health systems are stressed by patient surges. Many PC teams rely on referral-based consultation methods that can result in needs going unidentified and/or unmet. Here, we describe a novel system to proactively identify and meet the PC needs of all patients with COVID-19 being cared for in our hospital's intensive care units. Patients were screened through a combination of chart review and brief provider interview, and PC consultations were provided via telemedicine for those with unmet needs identified. In the first six weeks of operation, our pilot program of proactive screening and outreach resulted in PC consultation for 12 of the 29 (41%) adult patients admitted to the intensive care unit with COVID-19 at our institution. Consultations were most commonly for patient and family support as well as for goals of care and advance care planning, consistent with identified PC needs within this unique patient population.

Keywords: COVID-19; Palliative care; critical care (ICU); screening criteria; triggers.

MeSH terms

Betacoronavirus*
COVID-19
Coronavirus Infections / therapy*
Critical Care*
Health Services Needs and Demand*
Humans
Palliative Care*
Pandemics
Pneumonia, Viral / therapy*
SARS-CoV-2