A Telehealth Program for Advance Care Planning During COVID-19
This poster outlines a telehealth program launched by the CSU Institute for Palliative Care at CSUSM and the San Diego Compassionate Care Coalition to provide advance care planning/POLST education to residents of skilled nursing facilities (SNF) and similar care facilities now closed to visitors due to COVID-19. The pandemic compounds the need for ACP and POLST conversations, yet infection controls make it difficult to support patients who want to file or update their documents. In response, our project employs telehealth technologies to bring education and support to SNF patients, clients, and families wanting to update or complete a POLST form.
With logistical assistance from facility staff, our project uses Zoom (e.g.) to connect a trained POLST/ACP educator with the patient and/or family representative(s). By such means, a high quality POLST planning conversation may occur, prior to a new or updated POLST being co-signed and filed by the patient’s clinician. Our POLST/ACP educators provide needed support to staff and residents; ascertain that POLST forms are filled out completely and accurately; and above all, ensure that patients and families understand the treatment indications, benefits, and burdens, as they articulate wishes for future life sustaining treatment.
Our project is now in a pilot phase. We are currently working with two sites and conducting our first beta-test conversations. Early results are promising, in terms of accurate and timely POLST completion, filing, and patient satisfaction.
Our project includes two additional aspects. First, we have built in an educational component (a monthly POLST/ACP training webinar) that is open to partner-facility staff but is primarily directed to graduate-level students entering into healthcare professions. Students who have completed this training session will have the opportunity to attend and observe actual online POLST education conversations (with patient/family consent). Second, our project also links facilities to San Diego Health Connect, which is developing a secure digital health information exchange for San Diego County healthcare agencies and institutions. SDHC has instituted an “e-POLST Registry” to archive e-copies of POLST forms from agencies across the county, making them immediately available to EMT’s and hospital ED’s county-wide. We encourage our partner SNF facilities to join the exchange, so that the POLST forms that we create or update enter the registry.
We hope that the promise of our model is self-evident. Our goal is to elevate both the quantity and quality of completed POLSTs, and to prepare a host of future ACP patient educators, across healthcare disciplines and professions.
Author: Michael F. McDuffie, PhD, CSU San Marcos