Thread by @CroakeyNews

Chaired by Dr Will Cairns OAM, introduces some of the early discussions about #palliativecare - identified key issues - continuity of care, caring for new patients with new conditions, caring for #COVID19 patients and also #palliativecare colleagues #21OPCC

Communication and international collaboration vital for management of #palliativecare during pandemic #21OPCC

Vital for #palliativecare providers to document their experiences of #COVID19 #21OPCC

First up is Dr Anjali Raghavan, from @Austin_Health talking about 'Rapid transfer from ICU to PCU so families can be present during COVID lockdown' #21OPCC

@Austin_Health Dr Raghavan began her journey in #palliativecare at the beginning of 2020, just as #COVID19 pandemic began #21OPCC

End-of-life care has always been an important part of intensive care medicine #21OPCC

Pillars of #palliativecare open communication are vital to reducing stress at end-of-life. #21OPCC

Increasing role for transfer from ICU to PCU during pandemic - little research about this, which is the motivation for this project #21OPCC

12 patients transferred from ICU to PCU over 5 month period.
Mean length of stay in ICU was approx 9 days #21OPCC

Decisions to move to PCU were discussed with family members within 24 hours of decision #21OPCC

Consistent handover by consultive #palliativecare teams to inpatient #palliativecare team.
Approx 1/3 transferred out of hours. #21OPCC

Time from transfer from ICU to death was variable, between 35 min and 6 days. #21OPCC

The limited available data about families experience of this time, during the pandemic, indicates mixed emotions, gratitude, distress, anger (directed at experience of health care prior to this time), #COVID19 added to stress #21OPCC

Research identified potential areas for improvement of the transfer process - planning and communication, and in transition from active to supportive management #21OPCC

Jia Yin Tay and Rachel Everitt talk about 'COVID19 end-of-life care: symptoms and supportive therapy use in an Australian hospital' #21OPCC

#COVID19 significant impact on healthcare worldwide. Aim of study to describe clinical characteristics, symptomatology, medications and use of supportive therapies in patients who died from #COVID19 in a Victorian hospital #21OPCC

58 patients died from #COVID19 during the study time-period. Average age 87 years old. #21OPCC

Hypertension and dementia most common comorbidities in the cohort. #21OPCC #COVID19

Most common end-of-life care symptoms in the people included in the study incl breathlessness, pain, and agitation #21OPCC

90% of patients required opioids for pain management in final days #21OPCC

Respiratory secretion less common in #COVID19 terminal phase when compared to non-COVID patients.
Breathlessness most prevalent symptom. #21OPCC

Interesting - Cough not a very prevalent symptom in the terminal phase, even though it is one of most common symptoms in acute phase of the virus. #COVID19 #21OPCC

Only 8 out of the 58 patients were referred to #palliativecare consultancy in the last days of life - is important to find out what barriers exist and how the #palliativecare role can be expanded in future #COVID19 #21OPCC

Interesting comments in the chat asking how specialist #palliativecare referrals can be improved #21OPCC

Michelle Wood from Banksia Palliative Care is up next to talk about 'Unsung heroes: providing front-line, face-to-face community palliative care during a pandemic lockdown' #21OPCC

Michelle asks us to think about where we were when we first heard about #COVID19 #21OPCC

Banksia Pall Care is a 24-hour service, providing specialist service at no cost. Referrals to #palliativecare increased during 2020/21 #COVID19, as well as admissions and deaths #21OPCC

Michelle discusses the challenges of delivering expert community #palliativecare through a pandemic #21OPCC

Challenges incl = adapting, learning about #COVID19, social distancing, risk management, lockdowns.
The management team have been v supportive. #21OPCC

Supplies of basic equipment was a huge challenge for them #COVID19 #21OPCC

Michelle tells a story about how they were getting PPE supplies from a local tattooist, as their usual suppliers were unable to provide them with equipment.
Everyone chipping in to help each other - great community effort during #COVID19 #21OPCC

"Clients didn't want to go to hospital, with the fear of isolation and dying alone" during the pandemic #COVID19 - 21OPCC

Very difficult to manage symptoms over telehealth, had to visit in homes #21OPCC

Staff were phenomenal in adapting to daily changes in restrictions. Michelle very grateful for her team #21OPCC

How to provide #palliativecare during a pandemic - Take a really deep breath, gather with your colleagues, put your heads down and make a difference in a lot of people's lives - Michelle #21OPCC

Jennifer Philip is the final presenter in this session, 'Palliative Care and COVID-19'. She is talking about 'Outpatient palliative care telehealth during #COVID19 and beyond: a mixed method evaluation' #21OPCC

The study to evaluate telehealth during #COVID19 was conducted in Victoria during 2020 and 15 weeks of lockdown, conducted survey and qualitative interviews with patients and clinicians. #21OPCC

The study found that many of the telehealth consults were about provision of pain management, the remaining were general follow-up #21OPCC

Telehealth during #COVID19 improved continuity of care and enhanced relationships #21OPCC

Telehealth during #COVID19 has also been beneficial for joint consultations, incl GP, specialist and #palliativecare #21OPCC

Loss of physicality of usual #palliativecare delivery .
A mix of telehealth and in-person appointments might work well in future #21OPCC

Q&A 'COVID19 and Palliative care session' #21OPCC
Q for Anjali - was there urgency for the transfers from ICU to PCU?
A - natural progression of events

Q for Jia and Rachel - interested to hear that #COVID19 patients had relatively low doses of medications?
A - Became unwell quite quickly, initiating doses at levels used to taking in aged care setting #21OPCC

Q - do you think patients comfortable at end of life?
A - medication playing catch up. Distress quite common #21OPCC

From Anjuli - visitor restrictions in ICU very strict, no visitors allowed. But, slightly more relaxed in palliative care units #21OPCC

Q for Michelle - why do you think number of referrals increased so much in 2020?
A - more referrals came from oncologists. Suspect it may be because the team at Banksia were active and other healthcare services may not have been. More referrals also from aged care #21OPCC

A from Michelle cont...- team at Banksia were active in the community, and able to provide hands-on support #21OPCC #COVID19

Sorry, missed Q for Jenny...
A - community services under the pump, telehealth doesn't need to be an either or. Gradual transition. #21OPCC