Palliative Care Program Response to COVID-19: Wentworth-Douglass Hospital

Wentworth-Douglass Hospital in Dover, New Hampshire, is a 100-bed hospital affiliated with Partners HealthCare. This is a snapshot of their inpatient palliative care program's involvement in the hospital's COVID-19 response, based on an interview with Jennifer Powers, MHA, CHPCA, Palliative Care Practice Manager, and Agata Marszalek Litauska, MD, Director of Palliative Care, on May 12, 2020. At the time of the interview, COVID-19 was present in the area; however, the hospital had not seen as many cases as they expected, and their critical care unit capacity was not exceeded.

• Palliative care valued by leadership and hospital administration, so part of planning for the response
• Palliative care Director led the hospital’s crisis planning for staffing, space, and supplies
• Community planning
  • Home health agencies and hospices in the area had no issues with PPE; therefore, they have been ready and prepared to see COVID-19-positive patients

• Providing visits to all inpatients whether or not they are positive for COVID-19
• Providing on-site presence and support
• Disseminating just-in-time palliative care clinical tools (from CAPC, VitalTalk, and the Serious Illness Care Program) to the hospital and community
• Coaching PCPs on advance care planning (ACP)
• Clinical partnerships are flexible to the daily work (have seen more patients in the ICU than the ED)
• Most outpatient palliative care transitioned to telehealth (but maintained a physical presence in Seacoast Cancer Center)

Note: Palliative care census remained the same. Overall, the hospital saw fewer patients who needed more care.

Collaboration

• Consider the emotional and physical exhaustion of planning and waiting for COVID-19 to appear
  • Prioritize having all interdisciplinary team members work to full scope of practice (specifically nursing and social work)
  • Consider the increase in time for on-site health visits due to donning and doffing PPE

Clinical Care

• Support the organization’s plan, and use palliative care expertise to guide the plan

Personnel

• Be flexible in staffing design:
  • Initially boosted number of hours on site for March and April (moved from four days a week per person to five days per person)
  • Social worker and chaplain rotated one week on-site and one week off-site
  • Social worker and chaplain participated in the staff hotline

Information Dissemination

• Consider the rapidly-changing information flow, an the impact of PPE on normal communication channels
• Make sure there is a consistent and regular information dissemination process

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