Palliative Care Program Response to COVID-19: Northwell Health

The palliative care program at Northwell Health serves Long Island, New York, and Manhattan in New York City, covering twenty-three hospitals, a network of outpatient practices, and a hospice unit.

This is a snapshot of the palliative care program's involvement in Northwell Health's COVID-19 response, based on an interview with Sindee Weiss, MD, Medical Director, Palliative Care/Advanced Illness Unit-NSUH, and Tara Liberman, DO, Associate Chief of the Division of Geriatrics and Palliative Medicine, on April 7, 2020. At the time of the interview, Northwell Health was in the middle of the surge.

• Long Island and New York City were among the hardest-hit areas for COVID-19
• Community context:
  • Home health agencies doing telehealth, hospice not seeing COVID-positive patients
  • Long-term care placement tightly regulated; patients need to have two negative temperatures before they can leave (facilities will allow residents to return after hospitalization if they test positive for COVID-19

• Palliative care is at the table with senior Northwell Health leadership to lead COVID-19 response and guide resource utilization (screening, PPE, ventilator use)
  • Collaboration among legal, ethics, palliative care, and medical directors on system guidelines for communication with families when resources need to be redirected
• Supportive to the critical care team – collaborating with the ICU and ED
• Provision of palliative care education (coaching for telehealth consults and communication)
• 24/7 access as consultants or curbside counseling
• Palliative care unit still being used for palliative care patients (trying to keep the unit non-COVID)
  • Palliative care unit team and consult team are integrated
• Promoting advance care planning (ACP) in the ED, and in the community for high-risk and religious populations
• Outpatient palliative care patients and COVID patient visits (home, office, and inpatient) done via telehealth
• Consult patterns:
  • Due to low volume of non-COVID patients, less formal palliative care consultation and more trigger-based
  • Developed trigger for palliative care for COVID-19 patients: LACE score higher than 14; D-Dimer greater than 1000 (offer to assist with phone calls)
• Use of interdisciplinary team:
  • One MD and social worker on site
  • Social worker stationed on the palliative care unit to reach out with families
  • Chaplain and social worker doing work by telehealth
  • Fellows are working as hospitalists and may graduate early

Note: Palliative care census lower because hospital focus is on COVID care.

Prioritize Safety of Palliative Care Team Members

• Wear PPE at all times on site, and provide clear usage guidelines
• Clothing
  • Wear street clothes to and from site
  • Encourage on-site staff to wear scrubs
  • Leave a pair of shoes on site
  • Shower at home

Prepare for Video Visits

• Establish a process for non-face-to-face communication with consideration to platform (e.g., Northwell moved to Microsoft Teams, which has been essential for collaboration across settings and between all the hospitals)

Maintain Teamwork

• Service is on 24/7 so need to assure a workable schedule
• Plan for social distance when working on-site
• Make sure to support the team with daily or twice-weekly check-ins
• Determine who disseminates COVID-19 information

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