The Creation of a Psychiatry-Palliative Care Liaison Team: Using Psychiatrists to Extend Palliative Care Delivery and Access During the COVID-19 Crisis

Abstract

Context. During the course of March and April 2020, New York City experienced a surge of a 170,000 coronavirus disease 2019 (COVID-19) cases, overwhelming hospital systems and leading to an unprecedented need for palliative care services. Objectives. To present a model for rapid palliative care workforce expansion under crisis conditions, using supervised advanced psychiatry trainees to provide primary palliative services in the acute care and emergency setting. Methods. In response to the New York City COVID-19 surge, advanced psychiatry trainees at New York-Presbyterian Columbia University Irving Medical Center were rapidly trained and redeployed to a newly formed psychiatry-palliative care liaison team. Under the supervision of consultation-liaison psychiatrists (who also served as team coordinators), these trainees provided circumscribed palliative care services to patients and/or their families, including goals-of-care discussions and psychosocial support. Palliative care attendings remained available to all team members for more advanced and specialized supervision. Results. The psychiatry-palliative care liaison team effectively provided palliative care services during the early phase and peak of New York City's COVID-19 crisis, managing up to 16 new cases per day and provided longitudinal follow-up, thereby enabling palliative care specialists to focus on providing services requiring specialist-level palliative care expertise. Conclusion. By training and supervising psychiatrists and advanced psychiatry trainees in specific palliative care roles, palliative care teams could more effectively meet markedly increased service needs of varying complexity during the COVID-19 crisis. As new geographic regions experience possible COVID-19 surges in the coming months, this may serve as a model for rapidly increasing palliative care workforce.

Coronavirus disease 2019 (COVID-19) mortality and neighborhood characteristics in Chicago

“…Given the disruptions that the COVID-19-related deaths brought, this analysis identifies communities that may have unmet needs of supportive services,[ 46 , 47 ] and may benefit from the kind of “psychiatry-palliative care liaison teams”[ 48 ] that were deployed in New York City in response to the pandemic. Since SARS-CoV-2 continues to spread, this research can be used to help identify communities that may also benefit from additional resources and education that would improve their capacity to detect and prevent infection.…”

Emerging Palliative Care Innovations in the ED: A Qualitative Analysis of Programmatic Elements During the COVID-19 Pandemic

“…Two previous case studies have reported on individual programs that emerged during COVID in detail, [6][7][8] and a third outlined a comprehensive hospital-wide strategy including ED plans, which ultimately was not activated. 22 Our study adds a more comprehensive look at the breadth of new models and innovations.…”

“…While some PC-ED innovations have been reported in the literature [5][6][7][8][9][10] we anticipated that COVID might lead to the emergence of many more innovative models. Our primary objectives were to describe 1) the innovations in PC-ED integration that emerged during COVID and 2) the impacts of these innovations as perceived by clinicians who were involved in the implementation efforts.…”

A Comprehensive Approach to Palliative Care during the Coronavirus Pandemic

“…In early April, we trained psychiatry faculty, fellows, and residents in family supportive counseling and goals-of-care conversations. 9 Psychiatry's notable skills in communication made them an ideal choice to support palliative care. The training consisted of written materials and virtual workshops on communication tailored to COVID-19 patients.…”