key: cord-0078237-8v34euke authors: de Carvalho, Ricardo Tavares; Crispim, Douglas Henrique; Franck, Ednalda Maria; Santi, Daniel Battacini Dei; Anagusko, Sergio Seiki; Fukuda, Márcio Veronesi; Cavalcante, Luciana Suelly Barros; da Costa Pereira Jales, Sumatra Melo; de Queiroz, Mônica Estuque Garcia; de Oliveira Bonfá, Eloisa Silva Dutra title: Palliative care in the COVID-19 pandemic: strategy of HCFMUSP date: 2022-05-17 journal: Clinics (Sao Paulo) DOI: 10.1016/j.clinsp.2022.100050 sha: 51e9e4357f426ac4743ae588bfafe8c4737f97bf doc_id: 78237 cord_uid: 8v34euke nan A booklet was created with instructions and flowcharts involving the main communication modalities in this context: notice of worsening of the clinical picture, death news, family meetings for shared decision making [9] besides virtual visits from the families to the patients. A partnership was also made with technology companies from INOVAHC. This also made possible a lending contract for three robots with remote control and steering for communication actions. In all this context, the PC-IU organized the pilot actions, developed the action plans, and made possible the expansion of the communication project to the other CI. This was done with the help of volunteers, including FMUSP students, trained to give access to the equipment to hospitalized patients. The devices could also be used for family orientation at the time of hospital discharge. On 04/08/2020 the PC-IU was opened at CI specifically to care for patients who were assigned to the green group after triage protocol. The PC-IU had 24 beds that were managed in such a way as to keep suspected and confirmed cases isolated separately. The PC-IU operated with a local assistance team added to 2/3 of the PCT, medical and multi professional staff, and residents besides volunteer doctors from other areas and hospitals, with 24-hour coverage. Between 04/08/2020 and 07/31/2020, 186 patients were admitted to the PC-IU, with a median (IQR) age of 76 (65-86) years. The overall rate of discharge or transfer to a non-COVID area after treatment during this period was 32%, of which 62% had a confirmed diagnosis. Symptoms in the end-of-life phase were palliated appropriately, and palliative sedation therapy was used in 13 % of cases, a rate consistent with the experience of literature in PC units. [10] All patients had their advanced directives registered in their medical records and were not referred to the ICU. In parallel, in the same period, 310 inter-consultations were attended by the same team, of which 65% generated transference of the patient to the PC-IU within 72 hours, contributing to greater mobility of beds in critical areas. e) Post-death care and bereavement follow-up A professional from the PCT was assigned to be part of the team that welcomed the families after the notification of death by telephone. The families were instructed to go to the hospital to proceed with the legal issues related to the burial. On this occasion, they had the opportunity to be welcomed by a team assigned for this purpose. The families of patients who died in the PC-IU were screened for further outpatient follow-up based on markers indicating the possibility of complicated grief. About 50% of the triages performed led to a referral to the outpatient clinic. As final considerations, the planning of strategic actions in PC in the context of the pandemic brought positive aspects that included the dissemination of the work and the perception of the teams about the importance of PC in this context. This assistance brought visibility to the PCT and great interaction with the CI team, previously unaccustomed to this practice. It is important to say that the PCT decided to share their experiences in PC-IU and with inter-consultations write a book about Palliative Care during the COVID-19 pandemic. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. World Health Organization. Integrating palliative care and symptom relief into the response to humanitarian emergencies and crises: a WHO guide Efficacy of Manchester Triage System: a systematic review Supportive and Palliative Care Indicators Tool. SPICT-Br. (Brazilian version) The NHO Medical Guidelines for Non-Cancer Disease and Local Medical Review Policy: hospice access for patients with diseases other than cancer World Health Organization. UN Inter-Agency Task Force on NCDs and Covid-19 Conselho Federal de Medicina. Resolução CFM nº 1.805 Código de Ética Médica Comunicação difícil e COVID-19: recomendações práticas para a comunicação e acolhimento em diferentes cenários da pandemia Palliative sedation in terminal cancer patients admitted to hospice or home care programs: does the setting matter? results from a National Multicenter Observational Study The authors declare no conflicts of interest.