The palliative care program at MUSC provides inpatient care, and also serves patients through an outpatient palliative care clinic.

This is a snapshot of the palliative care program's involvement in MUSC's COVID-19 response, based on an interview with Patrick Coyne MSN, ACNS-BD, ACHPN, FPCN, FAAN, Director of Palliative Care, Kesha Graham LISW-CP, ACM-SW, NHDP-BC, Palliative Care Social Worker, and Hannah Coyne, MCS, BCC, Palliative Care Chaplain, from April 5, 2020. At the time of the interview, MUSC was in the early stages of the COVID-19 crisis and preparing for a surge.

Organizational Context for COVID-19

  • The organization is preparing for shortages of PPE and other equipment
  • Local hospice or home health agencies are taking new patients, including patients with COVID-19
  • MUSC is collaborating with The Carolinas Center (hospice and palliative care organization of North Carolina and South Carolina) to develop a COVID-19 response plan

Role of Palliative Care

  • Palliative care is part of MUSC's COVID-19 task force
  • Palliative care fellow embedded in the Emergency Department
  • Providing palliative care education to non-specialists through regular teaching
  • Incorporating telehealth into COVID-19 response:
    • Palliative care obtained five cell phones for the team to use for telehealth, and tablets to video conference with families due to visitation restrictions
    • One team member providing telehealth consults and family meetings to rural hospital
  • Use of interdisciplinary team:
    • Chaplain, social worker, and physician are part of MUSC 'encouragement team' to make sure hospital front line personnel feel supported (perform daily rounds, including in the ED)
    • Chaplaincy:
      • Chaplain and Bereavement Coordinator facilitating hospital-wide video debrief calls, available to all hospital staff
      • Part of daily sign-in and sign-out for ED staff
      • Providing spiritual care by telehealth – phone calls and caring voicemails, and prayers offered outside the door offer patients' and families' peace
    • Social work:
      • Use of FaceTime and Google Duo (video platforms) to connect families and patients
      • Identify domestic violence community advocacy resources since this is a major issue
      • Focusing on diversity issues – support for undocumented/underrepresented patients
      • Creativity in notarizing ACP documents
    • Bereavement Coordinator: Supporting hospital staff bereavement in addition to patients and families
    • Medical students: babysitting for staff
  • Palliative care census has been lower during COVID; referring partners are focused on MUSC's COVID response efforts

Advice from Palliative Care Leadership

Scheduling:

  • Expand to 7 day a week coverage and develop flexible scheduling (e.g. on 3 days and off 3 days)
  • Expect scheduling to change based on institutional need and team sustainability

Safety:

  • Require that all team members wear scrubs for infection control
  • Place cell phones in plastic bags within patient rooms for infection control
  • Plan for use of mobile phone app to disguise originating phone number for patient-related telephone calls - palliative care desk phone number appears, rather than personal mobile phone numbers

Education:

  • Get policies and procedures on the intranet within the system so anyone can access them

Teamwork:

  • Teamwork is important - team cohesion and ability to work as team is built on a foundation established before a crisis
  • Hold weekly team meetings to give updates and share issues
  • Consider the team’s role for the organization – reduce suffering in a holistic way, addressing physical, spiritual, and emotional needs
  • Double down on and encourage self-care; Patterns of self-care will change
  • Proactively discuss redeployment possibilities