As we are all facing an unprecedented time in healthcare with regards to the COVID-19 pandemic, the antecedent implication for Palliative Care teams and Hospices may be very dramatic. 

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.

Here is a list of Hospice and Palliative Care specific resources which may be helpful to you all. 

  1. Centers for Disease Prevention and Control (CDC) – Coronavirus (COVID-19)
  2. Medical College of Wisconsin
  3. Clinician Burnout and Resiliency
  4. Wisconsin Department of Health Services – COVID-19 (Coronavirus Disease) page 
  5. Wisconsin Medical Society – Physician resources for COVID-19 
  6. Center to Advance Palliative Care (CAPC)
  7. Supportive Care Coalition (SCC) – COVID-19 RESOURCES includes link to recorded webinar from 3/25/2020 – “Palliative Care and COVID-19: Implications for Clinical Practice, Part One” 
  8. Catholic Health Association of the United States – CORONAVIRUS RESOURCES 
  9. National Coalition of Hospice & Palliative Care (NHPCO) – COVID-19 Resources
    (This already includes most of the ones listed below)
  10. American Academy of Hospice and Palliative Medicine (AAHPM) – Resources to Address Coronavirus Disease 2019 (COVID-19) 
  11. VitalTalk – COVID-19 communication skills: a VitalTalk open source primer
  12. Serious Illness Conversations – COVID-19 Tip Sheet 
  13. The California State University Shiley Institute for Palliative Care (CSU)
  14. National Hospice and Palliative Care Organization (NHPCO) – COVID-19 Information
  15. Society of Critical Care Medicine (SCCM)
  16. University of Washington Medicine 
  17. Brigham and Women’s Hospital – COVID-19 Critical Care Clinical Guidelines 
  18. Journal Articles & Book Chapters
  19. Advanced Care Planning Resources 
  20. Blog Posts
  21. Podcasts 
  22. Social Media Links
  23. Meetings/Forums/Discussions/Webinars