Introduction The COVID-19 pandemic highlighted the need for high quality EOLC, unprecedented in scale and setting. We describe the initiatives led by the UCLH TEOLCT who played a key role in preparing and supporting staff to provide EOLC, as well as providing support for inpatients and their families.

Methods Utilising QI methodology, the TEOLCT rapidly implemented changes in six key areas of practice between 23/03/2020 and 25/08/2020. The multidisciplinary TEOLCT collaborated with Specialist Palliative Care and Clinical Psychology teams to achieve these outcomes.

Results (i) Staff education: high demand for teaching, e.g. difficult conversations, EOLC and COVID-19 specific symptom control, for redeployed staff largely inexperienced in EOLC. 1037 clinical staff were trained utilising a combination of socially distanced lectures and video-conferencing/webinars. (ii) Staff support: drop-in sessions were facilitated for >200 staff members. (iii) Guidance and Standard Operating Procedures: for symptom control, non-invasive ventilation withdrawal and communicating with family were collaboratively written and disseminated with appropriate training. (iv) Clinical audit: quality of decision-making and documentation scrutinised by auditing treatment escalation plans and do not attempt cardiopulmonary resuscitation orders, identifying areas of practice improvement and training needs. (v) Clinical support: modifying the SWAN model of care for patients in last days of life, TEOLCT supported care of 107 patients during the pandemic peak (23/03 ‘‘ 15/05/2020), totalling 255 inpatient visits. (vi) Bereavement support: with restricted visiting and changes to after death care, TEOLCT oversaw formal bereavement support for bereaved families of 348/392 patients who died, plus appropriate sign-posting to community services.

Conclusions The TEOLCT rapidly adapted to an unprecedented clinical challenge, identifying and responding to needs, working towards a common goal and leading a coordinated response to the demand for training and support. The key areas of development will inform future practice to ensure ongoing training and support in future surges.