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Early Intervention of Palliative Care in the Emergency Department During the COVID-19 Pandemic

Educational Objective
To understand how early intervention of palliative care can provide high-quality goals of care assessments during the COVID-19 Pandemic
1 Credit CME

During the novel coronavirus disease 2019 (COVID-19) pandemic, it is particularly critical to ensure that life-sustaining treatment (LST) such as intubation and resource-intensive cardiopulmonary resuscitation (CPR) are aligned with a patient’s goals and values, and to avoid LSTs in patients with a poor prognosis that are unlikely to be beneficial, but have a high risk of causing additional suffering.1 The high volume and acuity of COVID-19 patients makes it extremely challenging for emergency department (ED) clinicians to take adequate time to clarify goals of care (GOC). We implemented an ED-based COVID-19 palliative care response team focused on providing high-quality GOC conversations in time-critical situations. We examined the clinical characteristics and outcomes of patients who received this intervention.

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Article Information

Corresponding Author: Shunichi Nakagawa, MD, Adult Palliative Care, Department of Medicine, Columbia University Medical Center, 601 W 168th St, Ste 37, New York, NY 10032 (sn2573@cumc.columbia.edu).

Accepted for Publication: May 20, 2020.

Published Online: June 5, 2020. doi:10.1001/jamainternmed.2020.2713

Author Contributions: Dr Nakagawa had full access to all the data in the study and takes full responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Lee, Abrukin, Blinderman, Nakagawa.

Acquisition, analysis, or interpretation of data: Lee, Abrukin, Flores, Gavin, Romney, Nakagawa.

Drafting of the manuscript: Lee, Abrukin, Flores, Blinderman, Nakagawa.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Lee.

Administrative, technical, or material support: Gavin, Romney.

Supervision: Abrukin, Flores, Gavin, Nakagawa.

Conflict of Interest Disclosures: None reported.

References
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CDC COVID-19 Response Team.  COVID-19 response team. preliminary estimates of the prevalence of selected underlying health conditions among patients with Coronavirus Disease 2019-United States, February 12-March 28, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(13):382-386. doi:10.15585/mmwr.mm6913e2PubMedGoogle ScholarCrossref
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