Characteristics, Symptom Management, and Outcomes of 101 Patients With COVID 19 Referred for Hospital Palliative Care
Abstract Hospital palliative care is an essential part of the COVID 19 response but data are lacking. We identified symptom burden, management, response to treatment, and outcomes for a case series of 101 in patients with confirmed COVID 19 referred to hospital palliative care. Patients (64 male, median [IQR] age 82 [72 89] years, Elixhauser Comorbidity Index 6 [2 10] Australian modified Karnofsky Performance Status 20 [10 20] were most frequently referred for end of life care or symptom control. Median [IQR] days from hospital admission to referral was 4 [1 12] days. Most prevalent symptoms (n) were breathlessness (67) agitation (43) drowsiness (36) pain (23) and delirium (24) Fifty eight patients were prescribed a subcutaneous infusion. Frequently used medicines (median maximum dose/24h) were opioids (morphine, 10 30mg; fentanyl, 100 200mcg; alfentanil 500 1000 mcg) and midazolam (10 20mg) Infusions were assessed as at least partially effective for 40/58 patients, while 13 patients died before review. Patients spent a median [IQR] of 2 [1 4] days under the palliative care team, who made 3 [2 5] contacts across patient, family and clinicians. At March 30 2020, 75 patients had died, 13 been discharged back to team, home or hospice, and 13 continued to receive inpatient palliative care. Palliative care is an essential component to the COVID 19 response, and teams must rapidly adapt with new ways of working. Breathlessness and agitation are common but respond well to opioids and benzodiazepines. Availability of subcutaneous infusion pumps is essential. An international minimum dataset for palliative care would accelerate finding answers to new questions as the COVID 19 pandemic develops.
Journal of Pain and Symptom Management