The palliative care program at Hackensack Meridian Health (HMH) includes inpatient, post-acute, ambulatory, and home-based palliative care across a large health network in New Jersey.

This is a snapshot of the their involvement in HMH's COVID-19 response, based on an interview with Sage Kealy, MBA, MPH, Director of Palliative Care, Central and Southern Regions, on March 27, 2020. At the time of the interview, New Jersey was in the middle of the COVID-19 surge.

Organizational Context for COVID-19

  • At the time of interview, New Jersey had the second-highest number of confirmed cases in the country
  • HMH has used resources from CAPC's COVID-19 Response Resources toolkit
  • HMH is collaborating with other organizations for a regional approach to COVID-19 response
  • Community support
    • Hospice, home health, and long-term care organizations are taking patients with COVID-19; consideration is made based on community spread and appropriate PPE

Role of Palliative Care

  • Part of system-wide leadership response
  • Providing support to the network's primary care teams, COVID+-confirmed patients, and those under investigation
    • Co-manage symptoms, goals of care discussions, and provide psychosocial, spiritual, and emotional support to patients and families
  • Collaboration with care partners:
    • Palliative care participates in a daily huddle of leadership from all departments and divisions to ensure a harmonized approach
    • Continuously collaborate with various departments and leaders, including critical care, emergency medicine, patient experience, and quality
    • Participate in daily rounds with the ICU
    • Cultivating and building partnerships within the ED
  • Network-wide palliative care strategy:
    • Palliative care leadership facilitates a daily system-wide palliative care huddle
    • Palliative care teams working together across settings to support hardest hit campuses and locations
  • Promote and provide advance care planning and goals of care discussions in the community and across all settings to ensure goal-concordant care
    • Palliative care provides education to clinicians from other specialties through use of VitalTalk and Serious Illness Care Program communication resources
  • Expanding access through telehealth:
    • Clinical care is done with attention to minimizing use of scarce PPE and reducing exposure to patients and families
    • Patient visits (home, office, and inpatient) are done via telehealth whenever possible
    • Performing emergent telehealth visits across all settings, including those where physical exams are necessary
    • Palliative care teams are calling and checking in on all ambulatory and home-based patients, the majority of whom are isolated and afraid
  • Non-COVID patients need tremendous support, because they may have less connection with both their usual support systems and other providers, who are pulled into the COVID-19 response
    • Palliative care is assisting with care coordination, connecting the dots for families and providing much-needed emotional and spiritual support and psychotherapy

Note: Palliative care census has been very fluid during COVID-19. At the time of interview, more than 50% (and rising) of all inpatient consults across multiple campuses were for COVID-positive patients.

Advice from Palliative Care Leadership

Prepare for Change

  • Do not reinvent the wheel; use available resources such as CAPC's COVID-19 response tools
  • Try to anticipate system and local needs, and work proactively with community partners (hospice and home health agencies) based on their resources and bandwidth

Personnel

  • Be flexible, proactive, informed, and prudent; recognize the bravery of the team and focus on strategies to strengthen resilience

Safety of Palliative Care Team

  • With reduced resources and PPE, limit face-to-face and utilize telehealth whenever possible

Telehealth Visits

  • Establish processes for using telehealth, and acknowledge that they may be different than under normal circumstances
  • Develop triage protocols for telehealth services
  • Take time to develop rapport with new patients


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