Authors (including presenting author) :
Lam CYJ (1), Chiu HYH (1), Cheung KK (2), V Cho (3), Kwok OLA (1)
Affiliation :
(1) Palliative Care Unit, Medical and Geriatric Department, Caritas Medical Centre, Hospital Authority of Hong Kong
(2) Medical Social Work Department, Caritas Medical Centre, Hospital Authority of Hong Kong
(3) Clinical Psychology Department, Caritas Medical Centre, Hospital Authority of Hong Kong
Introduction :
The 5th wave of COVID-19 has overwhelmed Hong Kong health care system especially in Feb and Mar, 2022. Frail elderlies acquiring COVID-19 have been experienced higher incidence of critical illness and higher mortality rate. They are unlikely benefited from aggressive interventions. Palliative care (PC) consultative service becomes paramount for good symptoms control, psychosocial support and advance care planning (ACP) to keep them away from death with loneliness and sufferings.
Objectives :
To enhance PC support for frail elderly patients acquiring COVID-19 with critical illness.
Methodology :
A triage system was established for COVID ward doctors to refer frail patients with multiple comorbidities for PC consultative service. PC doctors and/or nurses would discuss ACP, assess physical, psychosocial needs of patients/ relatives, and if indicated, triage the patients/relatives to MSW and CP for further psychosocial and bereavement support. A retrospective analysis was conducted for data between period from 11 Feb 2022 to 24 Mar 2022 (~7 weeks).
Result & Outcome :
Total 176 patients were referred for PC consultative service, with mean age: 84.3 years old and mean Clinical Frailty Score = 6.4 (moderate to severe frail). The referred patients were assessed and intervened accordingly by doctor (n=95; 54.0%; 1-3 visits per patient); PC nurses (n=118; 67%; range:1-8 visits per patient); MSW (n=72; 40.9%; range: 1-8 visit per patient); CP (n=20; 11.4%; range: 1-4 visit per patient). Pharmacological interventions were prescribed for symptom relief (Opioid 26%; Midazolam 4%; Buscopan 10%; Haloperidol 2%; other drugs modifications 18%). All cases (100%) had ACP discussion, 87.5% had reach consensus with patient and/ or families with DNACPR order. Total 86 video calls were arranged by PC consultative team to facilitate communication of patient and family members. 109 patients (62%) already died before 1 May, 2022. The impact to PC team, experience of ACP discussion and conducting video call were reflected.
