17 Is routine inpatient COVID-19 testing appropriate in the hospice setting? an audit of clinical practice during the COVID-19 pandemic

Abstract

Introduction Data around end of life care in COVID-19 patients remains lacking. We present a study of 89 COVID-19 hospital patients who received specialist palliative care (SPC) input, which provides a novel understanding of the symptom needs of those dying from COVID-19. Methods Retrospective review of health-records of 89 COVID-19 patients with SPC involvement between 20/3/20-21/4/20. 54 pre-pandemic control patients referred to SPC between 20/ 11/19-20/12/19 were included as comparison. Results and discussion 84% (n=75) of COVID-19 patients had died at follow-up compared to 44% (n=24) of controls. Average time from SPC involvement to death was 3.4 days for COVID-19 patients and 8.3 days for controls. COVID-19 patients were more breathlessness (92%, n=69 vs 75%, n=18) and pyrexial (44%, n=33 vs 4%, n=1) than controls. Control patients were more likely to experience pain (58%, n=14 vs 17%, n=13). Agitation rates were similar in COVID-19 patients (45%, n=34) and controls (58%, n=14). High symptom burden and rapidity of deterioration in COVID-19 patients necessitated an increased use of continuous subcutaneous infusions (CSCI's), (69%, n=52 vs 46%, n=11). Median doses of opioids and benzodiazepines required in CSCI's to control symptoms were similar across both groups. Median 24 hr CSCI morphine equivalent dose of 15 mg (n=51) in COVID-19 patients vs 10 mg (n=10) in controls. Median CSCI midazolam dose of 10 mg in both groups (n=40 vs n=10 in controls). Few COVID-19 patients required glycopyrronium (n=15) and antiemetics (n=5) via a CSCI. Conclusion and recommendations COVID-19 patients have a rapid deterioration and symptomatic dying phase with different symptom profile to control patients. Symptom control in COVID-19 can be achieved with traditional drugs often at low doses, though with earlier use of CSCI's. Education and reassurance for generalists in the early use of opioids and benzodiazepines is essential to managing symptoms of dying COVID-19 patients.