Covid-19

Please find here practical tips/pointers to consider, as we try to prevent further spread and protect ourselves as we serve as resources to our colleagues on the frontlines.

1. Review any advance directive documents prior to intubation of elderly sick patients to make sure we are providing patient centered care.
2. Goals of care discussion, by EM/ICU doc or hospitalist prior to intubation, RE: harm/benefits (if any exist at all), of this intervention with patient/family or surrogates. Thanks to VitalTalk for providing this.
3. Consider telemedicine for family meetings if/when needed to avoid large groups if such discussions are needed for goals of care conversations. I believe most hospitals already have a visitor restriction policy in place. (Telemedicine Resources).
4. Coordination with pharmacy to ensure comfort medications are available and IT to make sure order sets are available across all sites should the need arise.
5. Involvement and Coordination with local Ethics teams, Pharmacy, Critical Care, Hospital Medicine and of course Palliative Care as the need arises.
6. Working with home care and hospice closely may be very key also in:
   • Keeping those sick at home and not bringing them to the hospital if not needed
   • Transitions from the ED to home if possible once it is determined being admitted isn’t beneficial 
7. If we have to place people on comfort measures, who are at the end of their life, it will be very lonely for them being in isolation and I wonder how we can help make it less so without putting staff, especially nurses at risk. Different facilities have different policies and most are making exceptions for dying patients so make sure to have clear communication with the facilities and health systems about what PPE is required and how to best support the dying patient.