Restructuring the Peri-operative Pain Service to Palliative Care as a Response to the COVID-19 Pandemic
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RESPONSE TO COVID-19/COMMENTARY
Restructuring the Peri-operative Pain Service to Palliative Care as a Response to the COVID-19 Pandemic Faye Rim, MD & Mary Kelly, FNP-BC, ONC, RN-C & Jefrey Meletio, LCSW & Spencer Liu, MD
Received: 5 June 2020/Accepted: 23 July 2020 * Hospital for Special Surgery 2020
Keywords
peri-operative pain . palliative care . COVID-19
Introduction Modern-day management of patients with musculoskeletal disease benefits from a full peri-operative pain service. These services include pre-surgical screening, inpatient pain consultation, post-operative transition planning, and if needed postoperative follow-up for complex pain issues [5, 6]. At the Hospital for Special Surgery (HSS), this service is called the Peri-operative Pain Services (POPS) and is an extension of the Department of Anesthesiology, Critical Care, and Pain Management. The team consists of three full time physicians, all with a background in pain management and palliative care, six advanced practice providers (APPs), and two licensed clinical social workers (with additional staffing provided by anesthesia residents and fellows as needed). POPS averages about 1000 visits across all services per month. Palliative care focuses on improving a patient’s quality of life by managing pain and other distressing symptoms of serious illness. Palliative care teams work to match treatment choices with patients’ goals, collaborating with patients, families, and other physicians to provide an extra layer of support. The Palliative Care Service at HSS was conceived in the Fall
of 2016 and became active in January 2017. This team-based consultative service, with representation from medicine, anesthesia, social work, and spiritual care, performed five to ten consultations per year prior to 2019. HSS Crisis Response HSS leadership decided to stop all non-essential surgeries on Tuesday, March 17, 2020, 5 days before New York State required the cancelation of elective surgeries. Our partners at NewYork-Presbyterian Hospital (NYP) faced a significant challenge due to the surge of patients being admitted for acute respiratory distress syndrome related to infection with SARSCoV-2, the virus that causes COVID-19. HSS alleviated their burden initially by accepting non-COVID-19 patients who needed further medical management. These included patients with pain issues such as sickle cell crisis and opioid tolerance. Some of these patients were transferred from NYPH on ventilator support to our critical care unit. Eventually, HSS received COVID-19 patients requiring ventilator support as well as supplemental oxygen support. HSS also opened an orthopedic triage center to divert emergent orthopedic cases from area hospitals. These cases included many patients with COVID19, and more often than not complex medical comorbidities. Peri-operative Pain Service Response
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11420-020-09782-4) contains supplementary material, which is available to authorized users. F. Rim,
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