Getting By With a Little Help from Our Friends: Palliative Care and Hospital Medicine Partnerships in the Pandemic

>
By Clarissa Johnston MD, FACP, Victoria Cooremans, MD, Sherine Salib, MD, FACP, Kirsten Nieto, MD, Snehal Patel, MD, FACP |  January 28, 2021 | 

This article is part of a series in The Hospital Leader written by members of the Division of Hospital Medicine at Dell Medical School at The University of Texas in Austin, exploring lessons learned from the coronavirus pandemic and outlining an approach for creating COVID-19 Centers of Excellence.

Patients dying without their loved ones, families forced to remotely decide goals of care without the physical presence or human connection of the care team, overworked staff physically isolated from their critically ill patients, and at-risk community members with uncertain and undocumented goals for care are among the universal challenges confronted by hospitals and hospitalists during this COVID-19 pandemic. Partnerships among Hospital Medicine (HM) and Palliative Care (PC) teams at Dell Medical School/Dell Seton Medical Center thrive on mutually shared core values of patient centered care—compassion, empathy, and humanity.

A key PC-HM collaboration was adapting our multidisciplinary huddle to focus on communication effectiveness and efficiency in the medical intensive care unit (MICU). Expanded interprofessional and cross-specialty collaboration promoted streamlined, succinct, and standardized communication with patients’ families while their loved ones were critically ill with COVID-19. The PC team attended daily MICU multidisciplinary huddles, attentive to both the medical and psychosocial updates for each patient. During huddles, residents or HM providers were asked to end their presentation with a clinical status “headline” and solicited feedback from the multidisciplinary team before messaging to the family. The PC team then communicated with families a succinct and cohesive medical update and continuously explored goals of care. This allowed the HM team, often overwhelmed with admissions, co-managing intensive care patients, and facilitating safe discharges, to focus on urgent issues while PC provided continuity and personalized support for patients and families. PC’s ability to synthesize and summarize clinical information from multiple teams and then provide cohesive updates in patient-friendly language modeled important communication skills for learners and simultaneously benefited HM providers.

Our chaplains, too, were central to facilitating timely, proactive conversations and documentation of Medical Power of Attorney (MPOA) for patients with COVID-19 admitted to our hospital. HM prioritized early admission conversations with patients to counsel them on severity of illness, prognosis based on risk factors, to elucidate wishes for intubation or resuscitation, and to capture their desired medical decision maker. HM was notified of all COVID and PUI admissions, allowing us to speak with even critically ill patients in the ER or ICU prior to intubation in order to quickly and accurately capture patients’ wishes for treatment and delegate decision makers. Our chaplains supported and supplemented these efforts by diligently and dutifully soliciting, hearing, and documenting patient MPOA delegates, with over 50% MPOA completion by 24 hours of hospitalization.

Another early PC-HM project, “Meet My Loved One,” was adapted from the University of Alabama at Birmingham Palliative and Comfort Unit. The absence of families visiting the ICU and sharing pictures, stories, anecdotes of our patients left a deeply felt, dehumanizing void in the halls and rooms of our hospital. To fill this space with life and humanity, furloughed medical students on their “transition of care” electives contacted family members of their “continuity” patients focusing primarily on those patients expected to have prolonged ICU or hospital stays and solicited personal, humanizing information about our patients. Questions included: “What is your loved one’s preferred name or nickname?” and “What are three things we should know to take better care of your loved one?” With family permission, we posted this information on the door outside the patient’s room. Nursing staff, in particular, appreciated getting to know their patients more personally and families appreciated the staff’s desire to know their loved one as an individual.

It is also important to acknowledge setbacks. Early efforts to engage technology proved more foe than friend. We continue to struggle with using our iPads for video visits. Most of our families prefer “WhatsApp” for video communication, which is not compatible with operating systems on early versions iPads, which were generously and widely donated by local school systems. Desperate to allow families to connect, many providers resorted to using personal devices to facilitate video visits and family meetings. And we discovered that many video visits caused more not less family angst, especially for critically ill patients. Families often required preparation and coaching on what to expect and how to interact with intubated, sedated, proned and paralyzed loved ones.

Our hospital medicine and palliative care teams have an established strong partnership. The COVID-19 pandemic created novel communication challenges but our shared mission toward patient-centered care allowed us to effectively collaborate to bring the patients goals of care to the forefront aligning patients, families, physicians, nurses, and staff during the COVID-19 surge.

 

Share This Post

Leave A Comment

For security, use of Google's reCAPTCHA service is required which is subject to the Google Privacy Policy and Terms of Use.

Categories

Related Posts

By Gian Toledanes, DO
March 17, 2023 |  0
Ableism is a common yet misunderstood “–ism”. Yet the common thread that ties ableism and other –isms/ forms of discrimination like racism, sexism, and homophobia, is the belief that one group or identity is “less than” others. Specifically, ableism is discrimination of and prejudice against people with disabilities and is rooted in the belief that […]
By Suchita Shah Sata, MD, SFHM
November 15, 2022 |  0
When RaDonda Vaught, a registered nurse at Vanderbilt University Medical Center, was criminally prosecuted for a medication error, it sent shockwaves through the medical community. Over 20 years after the landmark National Academy of Medicine (NAM) report To Err is Human and over a decade after Peter Pronovost catapulted the scientific approach to patient safety, […]
By Suchita Shah Sata, MD, SFHM
September 30, 2022 |  0
If you were designing the perfect hospitalist job description, what would be the optimal workload to achieve high productivity? This was the crux of the discussion during September’s JHMChat. The conversation featured Drs. Marisha Burden, Moksha Patel, Mark Kissler, and Elizabeth Harry as well as researcher Angela Keniston, coauthors of “Measuring and driving hospitalist value: […]
Go to Top