Department of Adult Palliative Medicine Service, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.
Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
J Palliat Med. 2021 Jul;24(7):1017-1022. doi: 10.1089/jpm.2020.0481. Epub 2020 Dec 1.
The COVID-19 pandemic resulted in a surge of critically ill patients that strained health care systems throughout New York City in March and April of 2020. At the peak of the crisis, consults for palliative care increased four- to sevenfold at NewYork-Presbyterian (NYP), an academic health care system with 10 campuses throughout New York City. We share our challenges, solutions, and lessons learned to help peer institutions meet increased palliative care demands during future crises and address pre-existing palliative care subspecialist shortages during nonpandemic times. In response to the increased demand, palliative care physician and administrative leadership at NYP piloted multiple creative care models to expand access to palliative care outpatient and inpatient services. The care models included virtual outpatient management of existing patients, embedded palliative care staff, education for providers, multidisciplinary family support, hospice units (which allowed for family visitation), and team expansion through training other disciplines (primarily psychiatry) and deploying an ePalliative Care service (staffed by out-of-state volunteers). Our comprehensive response successfully expanded the palliative care team's reach, and, at the height of the pandemic, allowed our teams to meet the increased demand for palliative care consults. We learned that flexibility and adaptability were critical to responding to a rapidly evolving crisis. Physician and family feedback and preliminary data suggest that virtual outpatient visits, embedded staff, hospice units, and team expansion through training other disciplines and deploying ePalliative Care services were impactful interventions.
2020 年 3 月至 4 月，COVID-19 大流行导致重症患者激增，纽约市各地的医疗系统都面临压力。在危机最严重的时候，纽约长老会医院（NYP）的姑息治疗咨询增加了四到七倍，NYP 是一个拥有 10 个校区的学术医疗系统。我们分享了我们的挑战、解决方案和经验教训，以帮助同行机构在未来的危机中满足增加的姑息治疗需求，并在非大流行时期解决预先存在的姑息治疗专科医生短缺问题。为了应对需求的增加，NYP 的姑息治疗医生和行政领导层试点了多种创造性的护理模式，以扩大姑息治疗门诊和住院服务的可及性。这些护理模式包括对现有患者进行虚拟门诊管理、嵌入姑息治疗人员、为医护人员提供教育、多学科家庭支持、临终关怀病房（允许家属探视）以及通过培训其他学科（主要是精神病学）和部署电子姑息治疗服务（由州外志愿者组成）来扩大团队。我们的全面应对措施成功扩大了姑息治疗团队的服务范围，在大流行高峰期，我们的团队能够满足增加的姑息治疗咨询需求。我们了解到，灵活性和适应性对于应对快速演变的危机至关重要。医生和家属的反馈以及初步数据表明，虚拟门诊、嵌入的工作人员、临终关怀病房以及通过培训其他学科和部署电子姑息治疗服务来扩大团队是有影响的干预措施。
