Palliative Care Program Response to COVID-19: Penn Medicine

The palliative care program at Penn Medicine in Philadelphia, Pennsylvania consists of an inpatient service, several outpatient clinics, and an affiliated home health agency and hospice.

This is a snapshot of the palliative care program's involvement in Penn Medicine's COVID-19 response, based on an interview with Rachel Klinedinst, DNP, AGACNP-BC, CRNP, CCRN, ACHPN, Advanced Practice Manager, Palliative Care Program at Hospital of the University of Pennsylvania and Penn Presbyterian Hospital, on March 25, 2020. At the time of the interview, Penn Medicine was in contingency preparation for a COVID-19 surge that was just beginning.

• Participating with Penn leadership on crisis response design
• Using a machine learning algorithm to identify high-risk patients with COVID-19 who would benefit from palliative care
• Providing proactive advance care planning (ACP) to non-COVID patients who do not want to go to the ICU; reaching out to existing palliative care patients to do ACP
• Assisting with COVID+ patients who do not want to go to the ICU; using Palliative Care Risk Score for realistic conversations
• Supporting palliative care delivery by non-palliative care specialists
  • Working with primary clinicians in adapting and disseminating CAPC and VitalTalk conversation scripts, and decision-making aides from Colorado, to help these teams do their work without needing to call for a palliative care consult
• Half the team is remote and half the team on-site
  • On-site presence as requested by institution since palliative care viewed as an essential service; team is practicing physical distancing
  • Daily rounds to divide the work and consider which person and which discipline is most useful in each situation
  • Social worker and chaplain doing supportive care; calling families to provide support, assisting with family contact with patients
  • All team members are reminding fellow colleagues that palliative care is available
• All visits done by telehealth unless a physical exam is warranted
• Community planning
  • Penn home hospice taking COVID+ patients
  • Inpatient hospice not taking COVID+ patients from hospital, but will from community
  • Many SNFs are closed so palliative care working with Penn-affiliated nursing homes to do telemedicine consults with the residents that focus on ACP

Note: Palliative care census lower with COVID-19; focus is on supporting non-COVID patients to safely remain out of the hospital.

Preparation

• It's never too soon to plan; once things start to happen, they change rapidly

Clinical Care

• Palliative care can assist with through-put of patients within the hospital

Collaboration

• Share the work

Team Safety

• Protect the team since they will be in it for the long haul

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