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COVID-19 Palliative and End-of-Life Care Plan: Development and Audit of Outcomes.
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.
  • Rao SR; Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India.
  • Rao KS; Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India.
  • Singhai P; Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India.
  • Gupta M; Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India.
  • Rao S; Department of Critical Care Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India.
  • Shanbhag V; Department of Critical Care Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India.
  • Balakrishnan JM; Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India.
  • Acharya RV; Department of General Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India.
  • Varma M; Department of Infectious Disease, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India.
  • Saravu K; Department of Infectious Disease, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India.
  • Munikrishna R; Department of Healthcare Operations, Kasturba Hospital, Manipal, Karnataka, India.
  • Thomas J; Department of Healthcare Operations, Kasturba Hospital, Manipal, Karnataka, India.
  • Muthanna CG; Department of Healthcare Operations, Kasturba Hospital, Manipal, Karnataka, India.
  • Shetty A; Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
  • Rao SK; Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
  • Salins N; Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India.
Indian J Palliat Care ; 28(3): 272-279, 2022.
Article in English | MEDLINE | ID: covidwho-1998154
ABSTRACT

Objectives:

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. Materials and

Methods:

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.

Results:

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%).

Conclusion:

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.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Systematic review/Meta Analysis Language: English Journal: Indian J Palliat Care Year: 2022 Document Type: Article Affiliation country: IJPC_59_2021

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Systematic review/Meta Analysis Language: English Journal: Indian J Palliat Care Year: 2022 Document Type: Article Affiliation country: IJPC_59_2021