As Mount Sinai hospitals filled with COVID-19 patients last spring, palliative care specialists became the lifeline for many of the seriously ill and their families in need of information about their conditions and future treatment plans. In their expanded roles, palliative care clinicians embedded themselves in emergency departments (EDs) and intensive care units (ICUs) to serve as care navigators, offering vital support to physicians and nurses overwhelmed by the volume of severely ill patients.

“Palliative care played a larger role than ever before,” says Emily Chai, MD, Vice Chair, Geriatrics and Palliative Medicine Inpatient Services. “We became a front-line specialty whose skills were more critical than ever in the midst of a pandemic with morbidity and mortality reaching levels no one could have imagined. We were able to provide patients and their families with medical management plans that honored their goals and wishes, and that enabled our inpatient teams to better utilize scarce resources like hospital beds and ventilators.”

Meeting the COVID-19 challenge required palliative care to quickly expand its repertoire of services. This led to development of a telemedicine program known as PATCH-24 (Palliative Care Helpline) that offered teleconsultation to clinicians caring for patients, and telemedicine to hospitalized individuals and family members. This effort would often unfold with a time-constrained physician in the ED calling on palliative care to initiate a more detailed conversation with the patient or patient’s family. PATCH-24 would allow for that interaction with a palliative medicine specialist or a geriatrician via Zoom.

“Telemedicine gave us the opportunity to update patients and their families on their condition and give them a sense of what their treatment would look like,” explains Dr. Chai, who is also a Professor of Geriatrics and Palliative Medicine at the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai. “Through these conversations we could explore with patients their goals and values. Many of the most sick, for example, didn’t want to be dying on machines in the ICU. They just wanted to be comfortable, and they wanted to be at home with their families. So we began expanding our Palliative Care at Home program as a bridge to home hospice.”

Palliative Care at Home is one of several home-based Mount Sinai programs to address gaps in health care delivery. Participants receive 24/7 hospital-level care from a team of nurse practitioners, nurses, and other Mount Sinai professionals. That care includes access to an on-call service that responds to urgent situations, regular visits from home care nurses who administer medications and check vital signs, and daily interaction with a physician or nurse practitioner, either in person or via video.

Another way palliative medicine grew its presence to meet the demands of the pandemic was through skills training of professionals outside its own department. Dr. Chai describes it as "a way to expand our workforce” by teaching people without palliative care experience how to initiate delicate end-of-life conversations with patients, and how to finesse the needs of family members unable to be at the bedside of their loved ones because of hospital visitor restrictions during COVID-19.

In all, more than 100 health care providers—including social workers, advanced practice nurses, and medical residents in fields ranging from radiation oncology to psychiatry to ophthalmology—were trained by palliative care professionals.

“We became very creative at a time when the need was so great,” says Dr. Chai. “It wasn’t until later on, when things subsided a bit, that we had the chance to look back and realize how much all of us had really accomplished.”