The University of Washington has both an inpatient and a small outpatient palliative care program. This is a snapshot of the program's involvement in the University of Washington's COVID-19 response, based on an interview with James Fausto, MD, Medical Director of Palliative Care at UW Medicine/University of Washington, on March 26, 2020. At the time of the interview, the organization was operating in a contingency capacity, anticipating a surge of COVID-19 patients in a few weeks' time.

Organizational Context for COVID-19

  • System-wide crisis planning approach
  • Community support
    • Since first large outbreak occurred in long-term care, there is mixed capacity among facilities to manage patients with COVID-19
    • Case-by-case capacity for hospice and home health agencies

Role of Palliative Care in COVID-19

  • Supportive to the ED and the COVID-19 ICUs/medical units
  • Part of system-wide decision-making on visitation rules (early, consistent enforcement of guidelines has been key)
  • Helping get advance care planning (ACP) and goals of care done to prepare for surge
    • Helping patients who are stable get out of the hospital to increase capacity for COVID-19 patients
    • Offering just-in-time consultation for ACP and goals of care conversations
    • Leveraging user-friendly VitalTalk communication resources
    • Coaching clinician colleagues on code status discussions
  • Acting as real-time consultants to clinical partners
    • Daily rounds in the ED
    • Disseminating information, education, and resources; balancing too much and too little
  • Outpatient practice has been small, but all patient visits are now done via telehealth
  • Interdisciplinary team plan
    • RN is liaison to other units such as cardiology
    • Social worker and chaplain are focused on staff support throughout the hospitals
    • Medical updates by MD, NP, or PA

Note: The organization's palliative care census has been lower during COVID-19. Referring partners are focused on COVID-19 response.

Advice from Palliative Care Leadership

Safety of Colleagues

  • Exposure is an issue and guides decision-making
    • Symptom management is more complicated due to isolation precautions and PPE concerns
    • Medication administration
      • Use of low-dose IV infusions instead of PRN IV or PO doses helps reduce nurse exposure
      • In some cases, keeping pumps outside of the room to dose-adjust without needing PPE

Leadership Challenges

  • Palliative care director needs to respond to system planning needs rapidly and sometimes in isolation
  • Hard to balance front line and administrative management

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

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