The Creation of a Psychiatry-Palliative Care Liaison Team: Utilizing Psychiatrists to Extend Palliative Care Delivery and Access during the COVID-19 Crisis

Shalev, Daniel; Nakagawa, Shunichi; Stroeh, Oliver M.; Arbuckle, Melissa R.; Rendleman, Rebecca; Blinderman, Craig D.; Shapiro, Peter A.

CONTEXT: Over the course of March and April 2020, New York City experienced a surge of a hundred and seventy thousand COVID-19 cases, overwhelming hospital systems and leading to an unprecedented need for palliative care services. OBJECTIVES: To present a model for rapid palliative care workforce expansion under crisis conditions, utilizing supervised advanced psychiatry trainees to provide primary palliative services in the acute care and emergency setting. METHODS: In response to the New York City COVID-19 surge, advanced psychiatry trainees at New York-Presbyterian Columbia University Irving Medical Center were rapidly trained and redeployed to a newly formed psychiatry-palliative care liaison team. Under the supervision of consultation-liaison psychiatrists (who also served as team coordinators), these trainees provided circumscribed palliative care services to patients and/or their families, including goals of care discussions and psychosocial support. Palliative care attendings remained available to all team members for more advanced, specialized supervision. RESULTS: The psychiatry-palliative care liaison team effectively provided palliative care services during the early phase and peak of New York City’s COVID-19 crisis, managing up to 16 new cases per day and provided longitudinal follow-up, thereby enabling palliative care specialists to focus on providing services requiring specialist-level palliative care expertise. CONCLUSION: By training and supervising psychiatrists and advanced psychiatry trainees in specific palliative care roles, palliative care teams could more effectively meet markedly increased service needs of varying complexity during the COVID-19 crisis. As new geographic regions experience possible COVID-19 surges in the coming months, this may serve as a model for rapidly increasing palliative care workforce.