Palliative Care Program Response to COVID-19: Lehigh Valley Health Network

The palliative care program at Lehigh Valley Health Network (LVHN) in Allentown, Pennsylvania is an inpatient, office, and home-based program covering eight network hospitals.

This is a snapshot of the palliative care program's involvement in LVHN's COVID-19 response, based on an interview with Donna Stevens, MHA, OACIS (Optimizing Advanced Complex Illness Support)/Palliative Medicine, and Nancy Fickert, DNP, FNP-BC, PMHNP-BC, ACHPN, palliative nurse practitioner, on April 10, 2020. At the time of the interview, LVHN was preparing for a COVID-19 surge, approximately two weeks behind New York City.

Crisis Service Design

• Palliative care collaborating with LVHN leadership on resource utilization and allocation
• Providing network education, resources, and tools on palliative care and communication
• Participating in daily briefing on network updates and changes to service delivery
• Community support
  • Palliative care continuing to refer and partner with home health and hospice
  • Telehealth options were quickly expanded at all sites, no “territory” boundaries
    • Closed office practice, transitioned patients to OACIS home-based palliative care practice
    • Risk-stratified home-based patients
• Direct services include advance care planning, symptom management, psychosocial, spiritual, and emotional support to patients and families and care coordination
• Implemented inpatient and outpatient plans for patients with serious illness or COVID-19
  • Proactively reaching out to existing home-based palliative care patients to review advance care planning (ACP) for COVID-19 and documentation in shared EHR to ensure appropriate resources at home and avoid dying alone
• Clinical partnerships
  • Promoting a visual presence each day and being proactive in how palliative care can be most helpful
  • Participating in COVID-19 clinic to see COVID+ patients post-hospitalization, if no PCP
  • Allocating resources to the ED for nurse practitioner in-person coverage; overnight on-call for tele-consults
• Telehealth
  • All visits done by telehealth unless a physical exam is warranted, utilizing billing codes for telephone visits, video visits, non-face-to-face visits
  • Outpatient video visits enabled by a LVHN smartphone app
  • Patients/families receive technical support before the visit
  • Inpatient visits done outside the room; tele-consults to all sites
• Use of interdisciplinary team
  • Daily huddles for inpatient and outpatient teams to connect and collaborate on patient needs
  • Administrative and clinical support staff assist with logistics
  • Social work making contact with patients to provide support and resources
• Outpatient palliative care census lower with COVID-19
  • Referring partners are focused on the COVID-19 response
  • Palliative care team making more patient touches in a day, due to increased access with new technology
  • Increasing patient support to address high levels of anxiety due to COVID-19
  • Making contact with new patients within twenty-four hours

Response Strategy

• Prioritize – response is local to the environment and the resources
• Get in touch with stakeholders and ask what would be helpful
• Be proactive and agile to ensure responsive action since each day changes

Technology

• Develop guidelines and templates for telephonic and video visits
• Prepare team for the differences between “tele” delivery of care and the usual high-touch palliative care delivery
• Prepare patients at home; consider access barriers and ways to overcome them
• Use of Tiger Text to stay connected to team, home health, and hospice

Team Wellness and Teamwork

• Be deliberate in reiterating the philosophy to help people do the most good with what they have
• Provide regular, consistent in-person contact, which is vital
• Require everyone to take a break every two hours, even at home
• Promote a STAND moment: Stop, Take a deep breath, Acknowledge what you are feeling, Notice how it is affecting you, Do something/Dance

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