Craig D Blinderman1,2, Ronald Adelman3,4, Deepa Kumaraiah5,2, Cynthia X Pan6,7, Brigit C Palathra6,7, Kate Kaley8, Noelle Trongone9, Kristen Spillane10. 1. Department of Adult Palliative Medicine Service, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA. 2. Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA. 3. Department of Adult Palliative Care, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA. 4. Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA. 5. Clinical Strategy and Service Lines, NewYork-Presbyterian, New York, New York, USA. 6. Division of Geriatrics and Palliative Care Medicine, NewYork-Presbyterian Queens, Queens, New York, USA. 7. Department of Clinical Medicine, Weill Cornell Medical College, New York, New York, USA. 8. Department of Oncology, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA. 9. Department of Oncology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York, USA. 10. Department of Strategy, NewYork-Presbyterian, New York, New York, USA.
Abstract
Context: The COVID-19 pandemic resulted in a surge of critically ill patients that strained health care systems throughout New York City in March and April of 2020. At the peak of the crisis, consults for palliative care increased four- to sevenfold at NewYork-Presbyterian (NYP), an academic health care system with 10 campuses throughout New York City. We share our challenges, solutions, and lessons learned to help peer institutions meet increased palliative care demands during future crises and address pre-existing palliative care subspecialist shortages during nonpandemic times. Methods: In response to the increased demand, palliative care physician and administrative leadership at NYP piloted multiple creative care models to expand access to palliative care outpatient and inpatient services. The care models included virtual outpatient management of existing patients, embedded palliative care staff, education for providers, multidisciplinary family support, hospice units (which allowed for family visitation), and team expansion through training other disciplines (primarily psychiatry) and deploying an ePalliative Care service (staffed by out-of-state volunteers). Conclusion: Our comprehensive response successfully expanded the palliative care team's reach, and, at the height of the pandemic, allowed our teams to meet the increased demand for palliative care consults. We learned that flexibility and adaptability were critical to responding to a rapidly evolving crisis. Physician and family feedback and preliminary data suggest that virtual outpatient visits, embedded staff, hospice units, and team expansion through training other disciplines and deploying ePalliative Care services were impactful interventions.
Context: The COVID-19 pandemic resulted in a surge of critically illpatients that strained health care systems throughout New York City in March and April of 2020. At the peak of the crisis, consults for palliative care increased four- to sevenfold at NewYork-Presbyterian (NYP), an academic health care system with 10 campuses throughout New York City. We share our challenges, solutions, and lessons learned to help peer institutions meet increased palliative care demands during future crises and address pre-existing palliative care subspecialist shortages during nonpandemic times. Methods: In response to the increased demand, palliative care physician and administrative leadership at NYP piloted multiple creative care models to expand access to palliative care outpatient and inpatient services. The care models included virtual outpatient management of existing patients, embedded palliative care staff, education for providers, multidisciplinary family support, hospice units (which allowed for family visitation), and team expansion through training other disciplines (primarily psychiatry) and deploying an ePalliative Care service (staffed by out-of-state volunteers). Conclusion: Our comprehensive response successfully expanded the palliative care team's reach, and, at the height of the pandemic, allowed our teams to meet the increased demand for palliative care consults. We learned that flexibility and adaptability were critical to responding to a rapidly evolving crisis. Physician and family feedback and preliminary data suggest that virtual outpatient visits, embedded staff, hospice units, and team expansion through training other disciplines and deploying ePalliative Care services were impactful interventions.
Entities:
Keywords:
COVID-19; family support; multidisciplinary collaboration; palliative care approach; redeployment of disciplines; virtual management of patients
Authors: Cristina M Beltran-Aroca; Rafael Ruiz-Montero; Antonio Llergo-Muñoz; Leticia Rubio; Eloy Girela-López Journal: Int J Environ Res Public Health Date: 2021-11-15 Impact factor: 4.614