Palliative Care in a Pandemic: A Retrospective Review of the Impact of Early Palliative Care Consultation During the Coronavirus Disease 2019 Pandemic.

Sabolish, Rachel M; Wilson, Jennifer M; Caldwell, Hollie K

During the coronavirus disease 2019 (COVID-19) pandemic, patients experienced rapid clinical decline requiring urgent conversations about their wishes for care. Palliative care advanced practice registered nurses developed a workflow to provide early palliative care consultation to every COVID-19 patient under investigation admitted to a 368-bed acute care hospital in the United States. A retrospective exploratory study was conducted on the initial surge from March 1 to May 31 of 2020. A nonrandomized 2-group design used descriptive and inferential statistics to compare elicitation of patient care preferences for patients who received early palliative care consultation with those patients who did not receive a palliative care consult. Early palliative care consultation resulted in a higher number of patients establishing a decision-maker (99%), changing code status (46%), changing goals of care (46%), and transitioning to comfort care (24%). In those patients not receiving palliative care, fewer patients established a decision-maker (10%), changed code status (7%), changed goals of care (4%), or transitioned to comfort care (3%). During the first COVID-19 surge, early palliative care consult performed by advanced practice registered nurses resulted in a higher number of patients establishing decision-makers and changing care preferences before decompensation due to COVID-19, thus helping patients avoid potential suffering caused by unwanted medical interventions.