Planning Beyond a Crisis: Steps for Finding Your Palliative Care Team’s "New Normal"

Possible Scenarios: Crisis-level volumes have started to drop at our hospital but I’m not sure when or if new non-COVID referrals will return to previous levels. Our organization laid off a lot of staff during the crisis and we aren’t sure how that will impact our program. The team is exhausted, and I’m worried that we may have another wave of COVID-19 patients at any time.

As the COVID-19 crisis-level volumes subside in some geographic areas, palliative care programs will likely find themselves in a period mixed with more uncertainty and unpredictability, striving to balance planning for the future while being on alert if their region experiences a “hot spot.” The following four steps provide a path for palliative care programs as they plan forward.

To begin planning for the future, it is important to step back and assess the health and availability of the team to both recover and learn from the crisis.

• Provide time and resources for the team to share their own experiences, assess what was learned within the crisis, and address wellness as a team (e.g. moral distress)
• Prioritize and assess patients, taking care to slowly ramp up to previous volume
• When possible, return to regular team meetings and schedules

During the crisis, new champions and relationships with key partners have likely been established (e.g., emergency department, ICU, community partners). These will be helpful in prioritizing and growing your impact over time.

• Offer to continue to round in the ED and be available to consult via phone
• Ask referring partners what they learned during the crisis and what they are now worried about with their complex patients
• As health systems and practices plan, learn when key clinical services will re-open

The crisis likely forced effective, creative, new processes and innovations that, if continued, will expand value and impact.

• Inventory and conduct a benefit/burden analysis of keeping new services, such as:
  • Rounding in ED
  • 24/7 phone support line
  • Use of telehealth
  • Refined referral criteria (triggers)
  • Documentation in EHR
• Prioritize and identify resources to further develop high-impact processes

Proactively develop a plan that outlines the actions and value provided during COVID-19, new opportunities for impact, and priorities for recovery. This will increase the likelihood of retaining and growing services.

• Make a list of the role the palliative care team played and new value-added services that demonstrated impact
• Ask referring providers to describe how the palliative care team integrated into their service and impacted patients
• Meet with leadership to review priorities, plans, and the team’s impact