Palliative Care Program Response to COVID-19: Baylor Scott and White Health

Baylor Scott and White Health (BSWH) is a health system in Texas that covers a region containing 11,000,000 people. It includes rural hospitals, community hospitals, one metropolitan academic medical center, and one small, community-based academic medical center.

This is a snapshot of the palliative care program's involvement in BSWH's COVID-19 response, based on an interview with Robert Fine, MD, Clinical Director of the Office of Clinical Ethics and Palliative Care, on April 4, 2020. At the time of the interview, BSWH was preparing for an expected COVID-19 surge in two to four weeks, depending on the region.

• Part of state-wide response with the Texas Medical Association and the Texas Hospital Association
• BSWH has had triage guidelines for an overwhelming pandemic for years
• Working with political (state and local) and faith-based community leaders on response in different counties
• The system has triage committees to support decisions in the COVID-19 crisis at the various hospitals – no MD stands alone in decision-making
• Community care:
  • Depends on part of state and PPE access as to whether home health agencies and hospices can take patients
  • In one facility, each member gets PPE for each day of the week, to store at the end of the day and use the following week

• Assist with co-management of patients (capacity depends on each hospital):
  • Evaluate comfort and assist with goals of care and advance care planning
  • Work with critical care teams (including daily rounds to determine where effort is needed)
  • All disciplines being used: chaplains, child life specialists, and social workers are mostly off-site and doing telephone calls
  • Refinement of CPR policy – will do CPR on everyone, but educating patients and families on what CPR means in the context of universal precautions, and the need for all staff to don PPE in order to preform CPR
• Disseminate education and tools for delivery of palliative care by non-specialists:
  • Use of palliative care order sets
  • Resources from the Serious Illness Care Program
  • Online course (Achieving Excellence in Palliative Care), and a two-hour in-person pain and symptom management course

Note: Because all elective surgeries and procedures have been canceled, BSWH's palliative care census has been lower during COVID-19.

Safety First

• Use universal precautions for all situations because COVID-19 carriers may be asymptomatic
• Be vigilant about staff protection; the program cannot afford to lose specialist palliative care team members

Care Delivery

• Prepare for the delivering palliative care in new ways
• Be flexible
  • Know that each institution will have unique needs; share practices that are successful
  • Accommodate geographic diversity

Palliative Care Response is Local

• Each site can only respond depending on its palliative care team size, bandwidth, and resources

Education

• The BSWH system wished they had been further along with Serious Illness Care Program when the pandemic hit; now trying to do training quickly with shortened versions of training sessions

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