A Vital Layer of Support: One Safety Net Hospital's Palliative Care Response to the Pandemic.

Abstract

Context: During the coronavirus disease 2019 (COVID-19) pandemic, New York City's public hospitals experienced a significant increase in the number of critically ill patients, especially from minority populations. The palliative care consult service at Bellevue Hospital, therefore, adjusted rapidly to meet the increased needs of our patients and colleagues. Objectives: To describe the dynamic palliative care needs during a public hospital's COVID-19 surge, including a process to utilize nonpalliative care trained volunteers to meet the increased demand for inpatient palliative care consults. Confronting the Challenge: Given the flexibility needed during the surge response, the consult team focused on three key elements to meet the system's needs: surge staffing, support, and scale. The consult service expanded into three individual teams to accommodate daily rounds with the medical intensive care and general medicine teams. Nonpalliative care trained community volunteers and internally redeployed providers received targeted training in advanced care planning and were subsequently embedded within the three teams, each led by a palliative care provider. A total of 12 volunteers joined the palliative care team. During eight weeks of the surge, the service cared for a total of 276 patients, 111 of whom were seen by volunteers. Over 50% of the palliative care patients had limited English proficiency. Conclusion: The inpatient palliative care consult service structure adapted rapidly in response to the increased need for advanced care planning and support throughout the hospital during the COVID-19 surge. Focusing on three key areas of surge staffing, support, and scale resulted in expert coordination with the hospital and system level leadership, efficient training of volunteer providers, and frequent re-evaluation of response strategies. These elements were vital in allowing the palliative care team to harness the expertise of various volunteer providers to meet the increased demands of a safety net hospital during the COVID-19 pandemic.