The palliative care program at Union Hospital in Elkton, MD covers Cecil County, MD and is led by two palliative nurse practitioners. Inpatient palliative care is delivered within a 96-bed hospital. A palliative care clinic provides care for patients in a large rural service area.

This is a snapshot of the palliative care program's involvement in Union Hospital's COVID-19 response, based on an interview with Brenda K. McKenzie, MSN, NP-C, CRNP, Christiana Care/Union Palliative care, on May 13, 2020. At the time of the interview, many geriatric patients in the region had tested positive for COVID-19, but critical care unit capacity had not been exceeded.

Organizational Context for COVID-19

  • A merger between Union and another hospital is in process
  • At the time of interview, hospice and home health agencies in the region were taking all patients – including those with COVID-19
  • There is a serious outbreak of COVID-19 in area nursing homes; the State of Maryland is coordinating clinical teams to provide support in nursing homes

Role of Palliative Care

  • Participating in a state-wide palliative care collaborative (supports rapid information-sharing during COVID-19)
  • Palliative care had not been part of crisis planning at Union Hospital, but this changed after a difficult patient death
  • Team is seeing both COVID-positive and COVID-negative patients; COVID-19 is an automatic palliative care consult trigger
  • Because the palliative care team is small with limited access to PPE, they must consider how they staff themselves. The two NPs rotate 1 week in the hospital and 1 week in the clinic. They may do a very rare home visit, if it will prevent a hospitalization.
  • Supporting hospital in various ways:
    • Palliative care helped transform outpatient and infusion area to a non-COVID-19 ICU
    • Union's Progressive Care unit is now a COVID unit
    • Palliative care social worker performs advance care planning
  • Team presents 'lunch and learns' on palliative care topics such as pain and symptom management to the hospital and community
  • Most care provided by the palliative care team is done via teleheatlh:
    • Team secured a new iPad to support palliative care delivery for patients in both the hospital and the clinic
    • Some in-person care is delivered for inpatients and clinic patients as dictated by the clinical situation
  • Palliative care census has decreased overall

Advice from Palliative Care Leadership

Collaboration:

  • Be willing to collaborate no matter how difficult
  • Consider the needs of the community (e.g. meals, emotional support)

Clinical Care:

  • Support the organization as new needs arise
  • Check in with staff after a patient’s death to offer support, particularly since there are many newly graduated nursing students

Personnel:

  • Think flexibly about scheduling during COVID-19, and be strategic about where and how to use scarce staff resources

Information Dissemination:

  • A challenge for teams during COVID-19 is rapidly changing information, which makes it difficult to focus on clinical care. Ensure that palliative care is included in the organization's regular chain of communication updates.