A Novel Illness, a Novel Communications Approach
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RESPONSE TO COVID-19/COMMENTARY
A Novel Illness, a Novel Communications Approach Mary Chisholm, MD & Mandip Kalsi, MD & Mary Kelly, MSN, FNP-BC & Bella Elogoodin, MBA & Bobby Stack, MSc & Douglas Green, MD
Received: 12 June 2020/Accepted: 8 September 2020/ * Hospital for Special Surgery 2020
Keywords COVID-19 . surrogate decision-makers . communication . intensive care unit The COVID-19 pandemic challenged New York City and its healthcare system in unprecedented ways. The significant increase in necessary critical care services, together with the suspension of normal visitation to prevent further spread, intensified and exacerbated the historical problem of providing quality physician–family communication in the intensive care unit (ICU) setting [11, 14]. To support New York City and New York-Presbyterian Hospital (NYPH), a tertiary care medical center with which the Hospital for Special Surgery (HSS) is affiliated; in late March 2020 HSS converted its 9th floor ambulatory operating rooms and post-anesthesia care unit into an ICU designed specifically for COVID-19 patients. HSS intensivists would be caring for an expected 400% increase in the number of ICU patients, going from a capacity of 4 beds to at least 16, with the possibility of expanding to 32 beds if needed. In effort to support HSS intensivists, a separate team was assembled to address communication with the families of hospitalized COVID-19 patients. This initiative, which came together in the family medical communications team (FMCT), assigned experienced physician volunteers, who were not providing clinical care Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11420-020-09803-2) contains supplementary material, which is available to authorized users. M. Chisholm, MD (*) : M. Kalsi, MD : M. Kelly, MSN, FNP-BC : B. Stack, MSc : D. Green, MD Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, NY 10021, USA e-mail: [email protected] B. Elogoodin, MBA Service Excellence Operations and Language Access, Hospital for Special Surgery, New York, NY 10021, USA
during this time, to the families of patients intubated in the ICU. Once assigned, and in coordination with a designated service excellence liaison (SEL), each physician updated the family daily on the patient’s medical status throughout the patient’s ICU stay. The standard for all medical decisions is to give preference to the patient’s voice as the central authority in determining goals of care [3]. When patients cannot speak for themselves, those who represent them become essential. But decisions familiar to the ICU staff about continuing and withdrawing life-sustaining treatments weigh heavily on family surrogates who struggle to articulate what they think the patient would have wanted [16]. The FMCT, through consistent daily communication, sought to meet the needs of these surrogates, to help them come to an understanding of the patient’s medical condition, to understand the patient’s values and pre
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