Palliative Care Program Response to COVID-19: Grady Health System

The palliative care program at Grady Health System in Atlanta, Georgia covers a 750-bed regional system that is trauma-centered and operated by two county systems. The program includes a palliative care clinic embedded within oncology.

This is a snapshot of the palliative care program's involvement in Grady Health System's COVID-19 response, based on an interview with Paul L. DeSandre, DO, FACEP, FAAHPM, Chief of Palliative and Supportive Care, on May 23, 2020. At the time of the interview, Grady Health System was in the middle of COVID-19 crisis.

• Mixed communication from the state on lifting sheltering in place restrictions and requirements for being out in public have created a challenge for the health system. The organization continues to be on alert with re-opening, and has fears about the potential to become a hot-spot for another COVID-19 surge.
• Providing hospice GIP; usually have scatter beds on units familiar with hospice philosophy; however, some units are now dedicated to COVID-19 care, resulting in the placement of patients on units unfamiliar with hospice philosophy, requiring significant staff education and coaching
• Overall, organization has been slower to adopt telehealth within clinics

Community planning

• Not enough PPE for hospice and home health agencies, leading to limitations on taking new patients
• Outbreaks in long-term care like the rest of the country, making discharge back to the those facilities difficult

• Palliative care not originally part of crisis planning; palliative care director reached out to key administrators to pose thoughtful questions about the role palliative care could play in the crisis
• Have been on-site to help the hospital care for patients, including COVID-19 positive, patients under investigation, and non-COVID palliative care patients
• Worked with hospital to create an end-of-life visitation policy for family members; including number of family visits, length of visit, type of PPE used by family, and the control, coaching, and supervision of visitors in donning and doffing PPE
• Pre-existing Palliative Education Committee is providing education on a just-in-time basis
• All disciplines within palliative care being used
  • Palliative care social worker is on-site to meet the psychosocial needs of patients and families
  • Chaplain (deployed to palliative care but housed under the chaplaincy department) providing spiritual care by telehealth - patients are receiving calls via room telephones and cell phones
  • Medical students helping to set up and observing meetings in which families say goodbye to patients

Note: Palliative care census was high prior to COVID-19; the team developed a process with ICUs to identify and prioritize those patients who needed palliative care the most.

Planning

• Ask questions early, to the right people, and be persistent

Education

• Promote consistency with visitation policies, particularly for end-of-life
• Promote real time palliative care communication skills coaching

Teamwork

• Talk with the team about the role of palliative care in the COVID-19 response
• Issues to review with the team:
  • Bandwidth
  • Ability to see the highest-priority patients
  • Overall feeling of lack of control

Underserved Populations

• Grady serves a largely African American population, which has had challenges accessing health care prior to COVID-19

This snapshot was consolidated, edited, and condensed by Constance Dahlin, MSN, ANP-BC, ACHPN, FPCN, FAAN, Consultant, Center to Advance Palliative Care.