key: cord-338279-so0hpph4
authors: Flores, Stefan; Abrukin, Liliya; Jiang, Lynn; Titone, Lauren; Firew, Tsion; Lee, Jihae; Gavin, Nicholas; Romney, Marie-Laure; Nakagawa, Shunichi; Chang, Bernard P.
title: “Novel Use of Telepalliative Care in a NYC Emergency Department During the COVID-19 Pandemic”
date: 2020-08-04
journal: J Emerg Med
DOI: 10.1016/j.jemermed.2020.08.008
sha: 
doc_id: 338279
cord_uid: so0hpph4

Abstract Coronavirus-2 (COVID-19) is a global pandemic. As of April 24th, mortality from COVID-19 has reached almost 200,000 people, with the United States (US) leading the globe in levels of morbidity and mortality. Large volumes of high acuity patients, particularly those of advanced age and with chronic co-morbidities, have significantly increased the need for palliative care resources beyond usual capacity. More specifically, COVID-19 has changed the way we approach patient and family member interactions. Concern for nosocomial spread of this infection has resulted in strict visitation restrictions that have left many patients to face this illness, make difficult decisions, and even die, alone in the hospital. In order to meet the needs of COVID patients, services such as Emergency Medicine and Palliative Care have responded rapidly by adopting novel ways of practicing medicine. We describe the use of telepalliative medicine (TM) implemented in an Emergency Department (ED) setting to allow family members the ability to interact with their loved ones during critical illness, and even during end of life. Use of this technology has helped facilitate goals of care discussions, in addition to providing contact and closure for both patients and their loved ones. We describe our rapid and ongoing implementation of TM consultation for our ED patients and discuss lessons learned and recommendations for others considering similar care models.

Coronavirus-2 (COVID-19) is a global pandemic. As of April 24 th , mortality from 3 COVID-19 has reached almost 200,000 people, with the United States (US) leading the 4 globe in levels of morbidity and mortality. Large volumes of high acuity patients, 5 particularly those of advanced age and with chronic co-morbidities, have significantly 6 increased the need for palliative care resources beyond usual capacity. More specifically, 7

COVID-19 has changed the way we approach patient and family member interactions. 8

Concern for nosocomial spread of this infection has resulted in strict visitation 9 restrictions that have left many patients to face this illness, make difficult decisions, and 10 even die, alone in the hospital. In order to meet the needs of COVID patients, services 11 such as Emergency Medicine and Palliative Care have responded rapidly by adopting 12 novel ways of practicing medicine. We describe the use of telepalliative medicine (TM) 13 implemented in an Emergency Department (ED) setting to allow family members the 14 ability to interact with their loved ones during critical illness, and even during end of life. 15

Use of this technology has helped facilitate goals of care discussions, in addition to 16 providing contact and closure for both patients and their loved ones. We describe our 17 rapid and ongoing implementation of TM consultation for our ED patients and discuss 

There are limitations with using TM for GOC discussions in the ED setting. In 94 order to address security and HIPPA violation concerns, we advocate for the use of 95 [11] . 102

To effectively provide palliative care and facilitate GOC conversations through the use of 104 TM, the need for further protocols must be considered. Although there has been growth 105 of telemedicine services, there is a lack of robust evidence regarding outcomes from the 106 clinical application of telemedicine in palliative care, let alone TM in the ED [8, 12] . 107

Further studies need to examine measuring the effects of palliative care interventions on 108 patient and family comfort, satisfaction, and physiological and emotional status. Most 109 importantly, this must be an interdisciplinary approach in coordination with palliative 110 care teams and EPs. 111

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Rapid Implementation of Inpatient Telepalliative Medicine Consultations during 168 COVID-19 Pandemic

Hersh 171 WR. Agency for Healthcare Research and Quality, US Department of Health and 172 Humans Services. Telehealth: Mapping the Evidence for Patient Outcomes From 173

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☒ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.☐The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:J o u r n a l P r e -p r o o f