ABSTRACT
Background and aim: Palliative care (PC) referral in serious COVID-19 patients improves decision-making, optimal health resource utilization, end-of-life symptom management, and family support. Development of a systematic decision-making matrix for PC referral for serious COVID-19 patients and an audit of its outcomes were explored in this study. Methods: Phase 1: A decision-making matrix for PC referral along with algorithms for managing symptoms and psychosocial needs of serious COVID-19 patients and their families were developed. Phase 2: Audit of outcomes of PC referral in hospitalized serious COVID- 19 patients was conducted using a pre-designed proforma. Disease demographics, illness variables, symptom management needs, and endof- life care preferences were recorded and analyzed. Results: Out of 1575 COVID-19 inpatients, 50 (3.1%) were referred to palliative care. Among 190 COVID-19 related hospital deaths, 20% (38) received end-of-life care. 88% were referred from ICUs, with 84% having >2 comorbid conditions. The median length of hospital stay was 14 days;the median duration between PC referral and death was 4 days. Among those who died with serious COVID-19 illness, PC referral had no impact on the duration of hospital and ICU stay. Among the 50 referred for PC, 47 (94%) were referred for goals of care discussion. 78% received opioids, 70% benzodiazepines, and 42% haloperidol for symptom management. 48 (96%) families participated in PC family meetings for documentation of end-of-life care preferences and 31 (62%) opted for limitation of life-sustaining treatment. 31 (62%) patients died in the ICU, while 7 (14%) died in the palliative medicine high-dependency unit. Psychosocial and bereavement support was offered to all. Conclusion: COPE-CP was accepted and implemented in the COVID ICU. PC referral enabled access to management of end-of-life symptoms and facilitated limitation of life-sustaining treatment in serious COVID-19 patients.
ABSTRACT
Background: Healthcare services were overwhelmed by the COVID-19 pandemic. Inpatient admissions for every pain crisis was not feasible owing to the scarcity of beds. This audit was conduced to explore the outcome of office-based interventions in managing pain crisis in a palliative care unit (PCU). Methods: An audit of electronic records of office-based interventions performed in adult patients for pain crisis in a PCU. Results: Thirteen office-based interventions were performed using appropriate measures in nine patients over a six month period (Table 1). The median pain score at presentation (after analgesic titration) was 8. Four patients with unilateral facial pain underwent trans-nasal sphenopalatine ganglion block (SPGB) and five patients with myofascial pain syndrome (MPS) underwent trigger point injection (TPI). All patients had satisfactory pain relief ( at least 50% post procedure pain relief) and none required inpatient admission for pain management. One patient each undergoing SPGB and TPI required repeat block after 3 and 2 weeks respectively. One patient underwent SPGB thrice. Except for 2 patients, all patients had medium to long term pain relief (range 14-150 days). None of the patients experienced any adverse effect. Majority of patients had significant improvement in sleep, mood, range of motion and activities of daily living. Analgesic doses were reduced in four patients and stopped in one. Conclusion: Office based interventions were feasible and effective in managing pain crisis and averted inpatient admission during the COVID pandemic.