Table 2.

Strategy for Palliative Care Consult Service Interactions With the ICUs During Conventional, Contingency, and Crisis Capacity

Strategy for ICU	Conventional Capacity	Contingency Capacity	Crisis Capacity
ICU—non-COVID-19 units 1.ICU can access onsite specialty palliative care seven days/week from 9 am to 6 pm, by consult request. In addition, palliative care telephonic coaching available 24 hours a day, seven days/week 2. Daily huddle with key ICUs to assess confirmed COVID-19+ for unmet palliative care needs or needs exceeding ICU team's capacity, prioritizing: a.Lack clear GOC or full code by default b.GOC or code status not aligned with prognosis c.End-of-life or moderate/severe symptom needs d.Family needing high levels of support Palliative care intervention • Assist through coaching or brief or full consultation 3.Follow contingency capacity approach regarding interaction and reasons for intervention and modify as follows: Palliative care intervention a.Invoke coaching or brief consultation, document critical content b.Lead symptom assessment and management including medication ordering c.Assist with transitions of care (i.e., withdrawing life support, GIP hospice, discharge on hospice) when applicable d.Support for implementing DNR orders based on medical appropriateness or scarce resource allocation models
	X
		X	X
			X
ICU—COVID-19 units 1. Palliative care will embed palliative care specialist in COVID-19 ICUs during daytime hours to assist & address: a. GOC and code status discussions with family/legal surrogate b. Coach ICU providers with complex GOC discussions c. Assist with documentation of transitions in GOC, transitions in site of care (i.e., GIP hospice, discharge with hospice) d. Support for implementing DNR orders based on medical appropriateness or approved scarce resource allocation models, including DNR based on informed assent or based on medical futility when appropriate After hours, palliative care on-call provider can assist with telephone support and coaching
		X	X

ICU = intensive care unit; COVID-19 = coronavirus disease 2019; GOC = goals of care; GIP = general inpatient; DNR = do not resuscitate.