Palliative Care Program Response to COVID-19: University of California San Francisco

The palliative care program at University of California San Francisco (UCSF) includes inpatient, outpatient, and home-based services.

This is a snapshot of the palliative care program's involvement in UCSF's COVID-19 response, based on an interview with Kara Bischoff, MD, Associate Division Chief for Outpatient Palliative Care, and Giovani Elia, MD, Associate Division Chief for Inpatient Palliative Care, on April 6, 2020. At the time of the interview, UCSF was preparing for an expected COVID-19 surge.

• System-wide COVID-19 response planning
• To address the shortage of PPE, UCSF is minimizing in-person visits for patients with COVID-19
• Community support for care of COVID-positive patients
  • Able to transfer palliative care patients to some hospice and home health agencies
  • Long-term care is afraid to take patients due to exposure of residents from people entering or returning to a site
  • Challenging to locate in-home custodial caregivers for patients, as well as placements in facilities

• Part of leadership committees designing UCSF's COVID-19 response
• Acting as real-time consultants for clinical partners
  • Routine consults for COVID+ patients in the ICU
  • Daily check-in with teams in the special Respiratory Inpatient Unit (RIU) for COVID+ patients
  • Urgent outpatient palliative care consults for COVID+ patients to address goals of care
  • Developing communication strategies with ED team
  • Disseminating CAPC Symptom Guidelines and VitalTalk communication resources
  • Available 24/7 to colleagues for consultation about communication (advance care planning (ACP) and goals of care conversations), symptom management, hospice referrals
  • Palliative care CNS acts as a liaison to various hospital floors
• All patient visits (home, clinic, and inpatient) have been converted to video visits in all specialties
  • Visiting patients with COVID-19 to address goals of care, provide symptom management, offer support, and help arrange caregiving plans
  • Participating in staffing of respiratory screening clinics
  • Staffing care for inpatients with respiratory symptoms potentially related to COVID-19
  • Providing urgent outpatient palliative care consults to help clarify goals of care for outpatients with suspected COVID-19
• Educating clinician colleagues in palliative care skills (including clinicians in the ED, ICU, primary care, oncology, and respiratory screening clinics)
  • ACP and goals of care conversations is a key area for education
• Creating a process to streamline ACP conversations across UCSF, including creation of a special form in their information platform with universal clinician access

Note: UCSF's palliative care census has been lower during COVID-19. Referring partners are currently focused on the COVID-19 response, but preparing for a surge.

Learn from Others' Experience

• Look to the regions of the country that have experienced high volumes of COVID-19 patients for strategies and to avoid pitfalls

Inpatient Lessons Learned

• Be as strict as possible with visitors
• Be strict with PPE rules early

Put A System in Place for Video Visits

• Ensure that all parties have the right equipment in place (device, camera, and video platform such as Zoom)

Teamwork

• Continue to support each other; have regular meetings and provide consistent information
• Find time for team self-care
• Get regular updates from leadership

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