Palliative Care Consultation in Hospitalized Patients With COVID-19: A Retrospective Study of Characteristics, Outcomes, and Unmet Needs

Abstract

Context: Few studies have described the characteristics and palliative care needs in hospitalized patients with coronavirus disease 2019 (COVID-19).

Objectives: Describing characteristics, consultation demands, patients' needs, and outcomes of hospitalized patients with COVID-19 who received a palliative care evaluation.

Methods: Retrospective chart review of patients (aged 18+ years) with COVID-19 admitted to an academic quaternary center and seen by the geriatrics and palliative medicine team from March 1st to May 11th, 2020. Socio-demographics, operational metrics, severity of illness, goals of care-advanced care planning documentation, and outcomes were analyzed.

Results: Three hundred seventy-six (17.6%) out of 2138 COVID-19 admissions were seen by the consultation team. Compared with prepandemic situation (September 1st, 2019, to February 29th, 2020), overall new consults (205 vs. 371, P < 0.001) significantly increased, particularly in the intensive care unit (ICU; 9.5% vs. 36.9%, P < 0.001). For the COVID-19 population, median age was 78 years (interquartile range, 70-87; range, 36-102); 56% were male. LACE score, D-dimer, and C-reactive protein suggested severe disease and increased risk of mortality. Seventy-five percent of consults were for goals of care-advanced care planning, and 9.6% for symptoms. During the index admission, 7.1% had documented advanced directives, and 69.7% became do not resuscitate. Of all deaths, 55.5% were in the ICU, and 87.2% were aged ≥65 years. Underserved minority patients had a disproportionate mortality. Overall consultation mortality (38.3% vs. 70.4%, P < 0.001) and ICU mortality (55.2% vs. 78.1%, P < 0.001) significantly increased compared with those before COVID-19.

Conclusion: During this pandemic, understanding inpatient specialized palliative care needs and the vulnerable populations driving these causes may encourage health-care agencies and local, state, and federal governments to support the dedicated palliative care workforce.

Keywords: COVID-19; Coronavirus Disease; Demographics; Needs; Palliative Care; Resources.

Fig. 1

Relative frequency of COVID-19 metrics comparing New York State with study site. Relative frequencies were calculated as the ratio between the number of cases per day and the total number of cases during the study period. The month of April represents the highest increase in relative frequencies for COVID-19 new consults, follow-up visits, and ICU admissions which correlates with the highest increase in relative frequencies for COVID-19 cases and hospitalization in New York State. Notice also that when the curve for New York State cases drops, the operational metrics for the study site also decrease.

Fig. 2

Relative frequency of COVID-19 metrics comparing New York State with study site. Relative frequencies were calculated as the ratio between the number of cases per day and the total number of cases during the study period. As also seen in Fig. 1, case frequencies for mortality data reach its peak during the month of April for both New York State and the study site.