Rao Seema Rajesh, Rao Krithika S, Singhai Pankaj, Gupta Mayank, Rao Shwetapriya, Shanbhag Vishal, Balakrishnan Jayaraj Mymbilly, Acharya Raviraja V, Varma Muralidhar, Saravu Kavitha, Munikrishna Rahul, Thomas Jibu, Muthanna C G, Shetty Avinash, Rao Sharath Kumar, Salins Naveen
Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India.
Department of Critical Care Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India.
Indian J Palliat Care. 2022 Jul-Sep;28(3):272-279. doi: 10.25259/IJPC_59_2021. Epub 2021 Oct 28.
Palliative care (PC) referral in serious and critical COVID-19 improves decision-making, health resource utilisation, end-of-life symptom management and family support. In this study, we explored developing a systematic decision-making matrix for PC referral in COVID-19 and audited its outcomes.
A team of interdisciplinary experts developed a hospital COVID-19 PC plan. PC referral and outcomes of PC referral in hospitalised COVID-19 patients were audited.
Out of 1575 inpatients, 1066 (67.7%) had mild and 509 (32.3%) had serious and critical COVID-19 illness. Among 50 (3.1%) referred to PC, 5 (0.4%) had mild and 45 (8.8%) had serious and critical COVID-19 illness. Out of 45 serious and critical COVID-19 patients referred to PC, 38 (84%) received end-of-life care (EOLC), 4 (9%) self-discharged against medical advice and 3 (7%) recovered. Forty-seven (94%) were referred for goals-of-care discussion. About 78% received opioids, 70% benzodiazepines and 42% haloperidol for symptom management. Among 45 serious and critical COVID-19 patients referred to PC, foregoing life-sustaining treatment was documented in 43 (96%) but implemented only in 23 (53%). Out of 38 who received EOLC, ICU was the place of death in 31 (82%) and ward in 7 (18%).
Despite interdisciplinary experts developing a hospital COVID-19 PC, low referral of serious and critical COVID-19 patients to PC was observed. PC referral enabled access to management of end-of-life symptoms and facilitated limitation of life-sustaining treatment in some COVID-19 patients with serious illness. Educating critical care physicians about the scope of PC in the COVID-19 setting might improve PC referral.
在重症和危重症新型冠状病毒肺炎（COVID-19）患者中进行姑息治疗（PC）转诊可改善决策制定、卫生资源利用、临终症状管理及家庭支持。在本研究中，我们探索制定一个用于COVID-19患者PC转诊的系统决策矩阵并审核其结果。
一个跨学科专家团队制定了一项医院COVID-19 PC计划。对住院COVID-19患者的PC转诊情况及PC转诊结果进行了审核。
在1575名住院患者中，1066名（67.7%）患有轻症COVID-19，509名（32.3%）患有重症和危重症COVID-19。在转诊至PC的50名（3.1%）患者中，5名（0.4%）患有轻症COVID-19，45名（8.8%）患有重症和危重症COVID-19。在转诊至PC的45名重症和危重症COVID-19患者中，38名（84%）接受了临终关怀（EOLC），4名（9%）违反医嘱自行出院，3名（7%）康复。47名（94%）患者被转诊以进行治疗目标讨论。约78%的患者接受了阿片类药物、70%的患者接受了苯二氮䓬类药物、42%的患者接受了氟哌啶醇用于症状管理。在转诊至PC的45名重症和危重症COVID-19患者中，43名（96%）有放弃维持生命治疗的记录，但仅23名（53%）实施了该措施。在接受EOLC的38名患者中，31名（82%）在重症监护病房（ICU）死亡，7名（18%）在病房死亡。
尽管跨学科专家制定了一项医院COVID-19 PC计划，但观察到重症和危重症COVID-19患者转诊至PC的比例较低。PC转诊使一些重症COVID-19患者能够获得临终症状管理，并有助于限制维持生命治疗。对重症监护医师进行关于COVID-19背景下PC范围的教育可能会改善PC转诊。
