Creating a Palliative Care Inpatient Response Plan for COVID-19-The UW Medicine Experience

James Fausto; Lianne Hirano; Daniel Lam; Amisha Mehta; Blair Mills; Darrell Owens; Elizabeth Perry; J Randall Curtis

doi:10.1016/j.jpainsymman.2020.03.025

Creating a Palliative Care Inpatient Response Plan for COVID-19-The UW Medicine Experience

J Pain Symptom Manage. 2020 Jul;60(1):e21-e26. doi: 10.1016/j.jpainsymman.2020.03.025. Epub 2020 Mar 31.

Authors

James Fausto¹, Lianne Hirano², Daniel Lam³, Amisha Mehta⁴, Blair Mills⁵, Darrell Owens², Elizabeth Perry⁴, J Randall Curtis⁶

Affiliations

¹ Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Department of Family Medicine, University of Washington, Seattle, Washington, USA.
² Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Geriatrics and Gerontology, Department of Medicine, University of Washington, Seattle, Washington, USA.
³ Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, USA.
⁴ Palliative & Supportive Care, UW Medicine/Valley Medical Center, Renton, Washington, USA.
⁵ Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA.
⁶ Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA. Electronic address: jrc@u.washington.edu.

Abstract

Context: The coronavirus disease 2019 (COVID-19) pandemic is stressing health care systems throughout the world. Significant numbers of patients are being admitted to the hospital with severe illness, often in the setting of advanced age and underlying comorbidities. Therefore, palliative care is an important part of the response to this pandemic. The Seattle area and UW Medicine have been on the forefront of the pandemic in the U.S.

Methods: UW Medicine developed a strategy to implement a palliative care response for a multihospital health care system that incorporates conventional capacity, contingency capacity, and crisis capacity. The strategy was developed by our palliative care programs with input from the health care system leadership.

Results: In this publication, we share our multifaceted strategy to implement high-quality palliative care in the context of the COVID-19 pandemic that incorporates conventional, contingency, and crisis capacity and focuses on the areas of the hospital caring for the most patients: the emergency department, intensive care units, and acute care services. The strategy focuses on key content areas, including identifying and addressing goals of care, addressing moderate and severe symptoms, and supporting family members.

Conclusion: Strategy planning for delivery of high-quality palliative care in the context of the COVID-19 pandemic represents an important area of need for our health care systems. We share our experiences of developing such a strategy to help other institutions conduct and adapt such strategies more quickly.

Keywords: COVID-19; palliative care; pandemic; strategic planning.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Academic Medical Centers
COVID-19
Coronavirus Infections / epidemiology
Coronavirus Infections / therapy*
Health Planning / methods*
Hospitalization*
Humans
Palliative Care / methods*
Pandemics
Patient Care Planning
Pneumonia, Viral / epidemiology
Pneumonia, Viral / therapy*
Practice Guidelines as Topic*
Universities
Washington