Table 3.

Strategy for Palliative Care Consult Service Interactions With the Medical/Surgical Acute Care for Conventional, Contingency, and Crisis Capacity

Strategy for Medical/Surgical Acute Care	Conventional Capacity	Contingency Capacity	Crisis Capacity
Medical/surgical acute care—non-COVID-19 units 1.Primary teams 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.Palliative care teams check in with primary team for COVID-19+ to autoassess based on EHR for unmet palliative care needs beyond primary team's capacity Palliative care intervention a. Coach/guide teams on GOC and code status discussions for patients with poor prognosis/at risk of intubation or resuscitation b. Consult if primary team needs assistance after first attempts on GOC c. Support for implementing DNR orders based on informed assent or medical futility when appropriate d. Assist with end-of-life or moderate/severe symptom needs Palliative care team members (social work & spiritual care) assist primary teams for unmet needs beyond primary team's capacity After hours, palliative care on-call provider can assist with telephone support and coaching 3.Follow contingency capacity approach regarding interaction and reasons for intervention and modify as follows: Palliative care intervention a. Daily huddle in person or by phone with key units to assess changing needs for COVID+ patients, including symptom management, GOC, end-of-life decisions, and family distress b. Invoke brief consult for high-needs cases c. Advise on GIP hospice and discharge with hospice opportunities were possible After hours, palliative care on-call providers can assist with telephone support and coaching
	X
		X	X
			X
Medical/surgical acute care dedicated to COVID-19 patients Palliative care intervention a. Daily huddle in person or by phone with key units to assess needs for COVID-19+ patients, including symptoms, GOC, end-of-life decisions, and family distress b. Invoke coaching or brief consult for high-needs cases c. Advise on hospice opportunities were possible After hours, palliative care on-call provider can assist with telephone support and coaching
		X	X

COVID-19 = coronavirus disease 2019; EHR = electronic health record; GOC = goals of care; DNR = do not resuscitate; GIP = general inpatient.