Kaya Ebru, Lewin Warren, Frost David, Hannon Breffni, Zimmermann Camilla
Department of Supportive Care, 7989University Health Network, Toronto, ON, Canada.
Division of Palliative Medicine, Department of Medicine, 7989University Health Network, Toronto, ON, Canada.
Am J Hosp Palliat Care. 2021 Jul;38(7):877-882. doi: 10.1177/10499091211005701. Epub 2021 Apr 7.
During the COVID-19 pandemic, hospitals worldwide have reported large volumes of patients with refractory symptoms and a large number of deaths attributable to COVID-19. This has led to an increase in the demand for palliative care beyond what can be provided by most existing programs. We developed a scalable model to enable continued provision of high-quality palliative care during a pandemic for hospitals without a palliative care unit or existing dedicated palliative care beds.
A COVID-19 consultation service working group (CWG) was convened with stakeholders from palliative care, emergency medicine, critical care, and general internal medicine. The CWG connected with local palliative care teams to ensure a coordinated response, and developed a model to ensure high-quality palliative care provision.
Our 3-step scalable model included: (1) consultant model enhanced by virtual care; (2) embedded model; and (3) cohorted end-of-life unit for COVID-19 positive patients. This approach was enabled through tools and resources to ensure specialist palliative care capacity and rapid upskilling of all clinicians to deliver basic palliative care. Enabling tools and resources included a triage tool for in-person versus virtual care, new medication order sets and guidelines to facilitate prescribing for common symptoms, and lead advance care planning and goals of care discussions. A redeployment plan of generalist physicians and psychiatrists was created to ensure seamless provision of serious illness care.
This 3-step, scalable approach enables rapid upscaling of palliative care in collaboration with generalist physicians, and may be adapted for future pandemics or natural disasters.
在新冠疫情期间，全球各地的医院都报告了大量有难治性症状的患者以及大量因新冠病毒病导致的死亡病例。这使得姑息治疗的需求增加，超出了大多数现有项目所能提供的范围。我们开发了一种可扩展的模式，以便在大流行期间为没有姑息治疗科室或现有专用姑息治疗床位的医院持续提供高质量的姑息治疗。
召集了一个由姑息治疗、急诊医学、重症监护和普通内科的利益相关者组成的新冠病毒病咨询服务工作组（CWG）。该工作组与当地姑息治疗团队建立联系以确保协调应对，并制定了一个确保提供高质量姑息治疗的模式。
我们的三步可扩展模式包括：（1）通过虚拟护理增强的咨询模式；（2）嵌入式模式；以及（3）针对新冠病毒病阳性患者的队列临终关怀病房。通过工具和资源实现了这种方法，以确保专科姑息治疗能力以及所有临床医生快速掌握提供基本姑息治疗的技能。支持工具和资源包括用于面对面护理与虚拟护理的分诊工具、新的药物医嘱集和指南以促进对常见症状的处方开具，以及主导预先护理计划和护理目标讨论。制定了通科医生和精神科医生的重新部署计划，以确保无缝提供重症护理。
这种三步可扩展方法能够与通科医生合作快速扩大姑息治疗规模，并且可能适用于未来的大流行或自然灾害。
