ABSTRACT
Outcomes: 1. Compare characteristics and clinical outcomes of inpatients with COVID receiving palliative care consultation (PCC) versus those who did not. 2. Elucidate evolution of PCC interventions over trajectory of successive COVID surges. Background/objectives: Palliative care (PC) teams have played an integral role in the care of critically ill patients hospitalized with COVID-19. This study describes how an inpatient, hands-on palliative care team adapted as the viral characteristics of the disease evolved. Method(s): Retrospective chart review of 2,879 patients, hospitalized with a primary diagnosis of COVID-19, at a large, urban academic hospital in Washington, DC from March 2020 through March 2022. Data was collected on baseline demographics, clinical characteristics, hospital course, and palliative care consultations (PCCs). Results were compared between patients receiving PCCs and those who did not. Trends in results were studied across the region's three surge periods, "Initial" (March 2020 to June 2020), "Delta" (November 2020 to April 2021), and "Omicron" (December 2021 to January 2022). Result(s): In-hospital mortality declined over the Initial, Delta, and Omicron surges with mortality rates of 17.5% (n=137), 13.6% (n=121), and 11.2% (n=62), respectively. ICU admission rates declined, with 21.6% (n=169), 21.3% (n=189) and 17.0% (n=94) for each of the surges. 393 (13.7%) patients received a PCC, with consult rates of 12.7%, 12.1%, and 14.3% for each surge, respectively. In-hospital mortality for PCC patients was 47.8% (41.1%, 51.2%, 40.9% by surge) vs. 9.3% for non-PCC (14.2%, 7.3%, 5.6%). Majority of PCC patients had COPD in Initial (87.4%, n=83) and Delta (93.7%, n=119) surges (14.8%, n=13 for Omicron). As hospital staff became acclimated to the pandemic and the sense of urgency declined, the days to PCC increased (7.1, 8.8, 10.1 days, respectively). During the Initial surge, the primary PCC interventions were for symptom management (28.5%, n=290), psychosocial support (18.9%, n=193), and goals of care (14.9%, n=152). Psychosocial support (13.5%, n=172) and goals-of-care (6.3%, n=80) interventions declined during the less acute Omicron surge (13.5%, n=172), while symptom management increased (38.2%, n=488). Conclusion(s): The demographic profile and viral characteristics of COVID-19 patients changed over the course of the pandemic, impacting both patient outcomes and palliative care's interdisciplinary response to the needs of patients and families.Copyright © 2023