The new normal: High volumes of acutely ill and dying patients.

As a licensed clinical social worker, professional case manager, and doctor in behavioral health student, concern for my colleagues on the front lines of care is absolute. That concern has me hitting pause this week for my usual report on the state of the social determinants of health and mental health (SDoH and SDoMH) for the industry. Instead, I will address the impact of the pandemic on our workforce. Their exposure to high volumes of acutely ill and dying patients has meant that most professionals have been exposed to more patient deaths these past nine months than expected for their entire career.

The pandemic has forced professionals and their organizations to practice without a relevant playbook. Proactive dialogues on pain relief, symptom management, and quality of life have been replaced by reactive attention to suffering for high volumes of critically ill patients on life support, many with limited chance of survival. For an industry reliant on templates and care maps to guide next steps, this new norm has been tough. Yet, amid any crisis, there is one constant: knowledge yields great power. To that end, today I will provide you with a series of new playbooks offering knowledge to support and facilitate your bereavement actions with patients and their families, colleagues, and own support systems.

The Center to Advance Palliative Care (CAPC) has developed the COVID-19 Response Resource Hub, a clearinghouse of  palliative care strategies, regulatory updates, protocols, and toolkits for interprofessional teams. The Hub’s emerging content leverages every aspect of palliative and end-of-life care. Step-by-step information sheets, scripts, and webinars offer education on support programs and staff development, symptom management, discharge, care planning resources, and Medicare and insurance waivers, as well as health equity and staff emotional health.

The CARE model, published in the Annals of Internal Medicine, was developed for physicians to comfort bereaved surviving family members. The acronym stands for:

  • Communicate compassionately;
  • Assess risk for acute bereavement challenges;
  • Refer to a mental health professional when indicated; and
  • Educate about resources.

Conversation maps have become especially valuable to maneuver difficult end-of-life care discussions with patients and families. Vital Talk has developed a series of and maps available free of charge to the professional public, addressing:

  • Goals of care;
  • Treatment realities, limitations, and prognosis;
  • Shared decision-making for vent withdrawal; and
  • Saying goodbye (virtually or in person).

Vital Talk also developed a COVID-19 Ready Playbook for practitioners of varied conversation maps specific to virus concerns, including:

  • Screening: when patients or staff are worried they’ve been infected
  • Preferencing: when patients want to opt out of hospitalization
  • Triaging: communicating with patients on point-of-care options
  • Admission: conveying need for hospitalization or ICU transfer
  • Counseling: addressing patient fears and emotions
  • Deciding: discussing when things are not going well, goals of care, code status
  • Resourcing: Informing patients and families of the ethical realities of rationing care
  • Notifying, anticipating and grieving: discussing prognosis, realities, and end of life.

Additional contingency planning and crisis playbooks developed by frontline practitioners are also available on the Vital Talk website (www.vitaltalk.org).

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