In light of the impact that COVID-19 has on our most vulnerable patients, clarifying goals of care is essential to providing the highest quality care and avoiding medical errors of overtreatment. And with a real possibility of ICU surge scenarios, it is unacceptable to admit patients to the ICU without clarifying treatment preferences in advance to ensure precious resources are allocated to those that need them most. We are here to support you in ensuring that your organization has advance care planning practices in place.
As a Pulmonary Critical Care physician, the past few weeks have been like nothing I have experienced in my career. Healthcare organizations across the country have been working to rapidly implement new processes and workflows to screen, diagnose and treat patients with COVID-19, as well as planning ahead for the potential increase in need for inpatient and critical care resources. It has been remarkable to see my clinical colleagues rally together, working around the clock to prepare for and manage this extraordinary situation.
In times like these, everyone is stressed – government, healthcare organizations, and citizens throughout the country, especially those who are or are caring for the elderly, frail, and seriously ill. And the US healthcare system is ill prepared for the influx that is yet to come. While there are still so many unknowns, and will be unknown in the coming weeks, there is one thing that is known – advance care planning has never been more important.
- Those at highest risk are older adults and those who have serious chronic illness such as heart disease, lung disease, and diabetes.
- 60% of Americans have at least one chronic illness, with 40% having more than one.
- A study in China showed that those with one chronic condition were 1.8 times more likely to be put on a ventilator or die verses those with no chronic condition. Those with 2 chronic conditions were at 2.6 times greater risk.
- Based on statistics from those countries ahead of the US, the virus could result in 10M-34M hospital visits. One-fifth of these patients will require intensive care. The estimated number of ICU beds in the US – 45,000. Just a moderate outbreak would require 200,000 ICU beds.
- In the US, there are only 2.8 hospital beds per 1,000 people. The average hospital bed occupancy rate is 65.9%, and of course varies hospital to hospital and season to season.
- Treatment for unexpected emergencies still needs to continue.
As is always the case, proper advance care planning could help in a number of areas, crisis or not – reduced ED visits, reduced ICU utilization, reduced number of hospitalizations, and increased hospice use. Advance care planning also identifies those who might prefer less aggressive treatment should they become ill. This becomes extremely important, especially during the current pandemic, as more (possibly all) beds and resources are needed to treat those diagnosed with COVID-19 and other emergencies.
I’ve always said, advance care planning should happen early and often. Although much of our focus is on the pandemic we are facing today, we are less than a month away from National Healthcare Decisions Day, a day dedicated to inspire, educate, and empower everyone about the importance of advance care planning. Here are a few of my favorite resources to help both clinicians and individuals:
- Ariadne Labs Serious Illness Conversation Guide – one element to a multi-component program, offering clinicians language to have a conversation around goals, values, and wishes.
- Center to Advance Palliative Care (CAPC) – provides essential tools, training, technical assistance, and connection for those clinicians caring for individuals with serious illness.
- The Conversation Project – a program dedicated to helping people talk about their wishes for end-of-life care.
- Five Wishes – helps guide structured advance care planning conversations and offers an easy-to-use advance care planning legal advance directive.
- VitalTalk – evidence-based, patient-centered training, empowering clinicians to have conversations with those who have serious illness.
In the midst of this pandemic, and given the demographic of impacted patients, goals of care conversations are more important than ever, as is having advance care planning documents available to clinicians to provide appropriate care, and to ensure resources are available to those who most need them most during these trying times.
Want to know how we can help? Contact us today!
Ryan Van Wert, MD is CEO and Co-founder of Vynca, and a part-time Clinical Assistant Professor at Stanford University.