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Palliative care in critically ill COVID-19 patients: the early New York City experience
  1. Jacqueline Sheehan1,
  2. Kam Sing Ho1,
  3. Joseph Poon1,
  4. Kimberly Sarosky2 and
  5. Jennifer Y Fung3
  1. 1 Department of Medicine, Mount Sinai Morningside & Mount Sinai West, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
  2. 2 Department of Pharmacy, Mount Sinai Morningside, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
  3. 3 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine and Department of Geriatrics & Palliative Care, Mount Sinai Morningside & Mount Sinai West, Mount Sinai Health System, New York, New York, USA
  1. Correspondence to Dr Jacqueline Sheehan, Department of Medicine, Mount Sinai Morningside & Mount Sinai West, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY 10029, USA; jacqueline.sheehan{at}mountsinai.org

Abstract

Objectives The COVID-19 pandemic in the USA has been accompanied by high rates of mortality and an unprecedented need for palliative care delivery. Little is known about the use of palliative care services in intensive care unit (ICU) settings during the COVID-19 pandemic.

Methods This is a retrospective cohort study of critically ill COVID-19 patients requiring ICU admission, between 7 March and 14 April 2020 to two academic teaching hospitals in New York City. Palliative care consultation included a one-time telemedicine consultation or continued telemedicine consultation and follow-up with multidisciplinary team involvement. Patient information was collected from the electronic health record and analyses were conducted with Stata V.15.1 (StataCorp) statistical software.

Results A total of 151 critically ill patients with COVID-19 pneumonia requiring ICU admission were identified, of whom 59 (39.07%) received an inpatient palliative care consultation. More than half of patients died (n=85/151, 56.29%), with 57.65% (n=49/85) of these patients receiving palliative care services during their hospitalisation. Patients who received palliative care consultation were more likely to be older, sicker and receive mechanical ventilation than their counterparts. Patients who died and did not receive palliative care were younger and required non-invasive ventilation support.

Conclusion There is a lack of utilisation of palliative care in COVID-19 patients admitted to the ICU. Further research into predictors of poor outcomes in critically ill COVID-19 patients may help identify patients that would benefit from early palliative care involvement going forward.

  • hospital care
  • respiratory conditions
  • supportive care

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bmjspcare-2020-002677

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    Footnotes

    • Twitter @jfungmd

    • Contributors All authors contributed to the writing of this manuscript. Statistical analysis was performed by KSH. Data collection was performed by JS, JP and KS.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.