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YNHH Embraces Comfort and Quality of Life with New Supportive Care Unit: Positive Change in a Time of Turmoil and Fear

October 04, 2020
by Elizabeth Horn Prsic and Ruth Arnold

Though we get daily reminders that the COVID pandemic is far from over, March through May 2020 may always be etched in the memories for YNHH and YSM faculty and staff, patients and their caregivers as a significant time. It is also a time when the Supportive Care Unit (SCU) at YNHH was organized. The professionalism and compassion of the SCU team and their impact on those first patients and their caregivers was remarkable and deserving of tribute. Christopher Ahern, DO, a palliative care fellow at the time, captures the feelings of many at SCU when he said, “I am proud of the medical care I provided during my time on the SCU but I'm most proud of the truly patient-focused team we built; we were all pushed out of our comfort zones and driven by our mission to bring compassionate end-of-life care to those most in need. As a united team, we were able to weave together our different skill sets and our true love of this difficult but sacred work into a physical and emotional space - a sheltered place in the midst of a pandemic storm.”

The Supportive Care Unit of Yale New Haven Hospital opened in April 2020 during the peak of the coronavirus pandemic in Connecticut. It is dedicated to comfort-focused and end of life care for patients throughout Yale New Haven Hospital. It was developed to provide a structured, subspecialized approach to the unique needs of these patients and their caregivers and families. It is supported by the full interdisciplinary palliative care team, including social work, spiritual care, art therapy, bereavement counseling, pharmacy, as well as palliative care physicians and APRNs. The unit works closely with Vitas for comprehensive end-of-life support for patients pursuing inpatient hospice care.

The Unit initially opened on Smilow North Pavilion 4. Despite the enormous challenges of the time, the palliative care program and nursing leadership, led by Leah Barton, MSN, RN, brought together a diverse team of caregivers for the Supportive Care Unit and helped promote a culture of caring. From the beginning, the unit served to support patients, many of whom were unable to visit with caregivers and families due to either visitor restrictions or to individual quarantine, health, and safety needs. Christopher Ahern, DO, who served as a palliative care fellow this spring, says, “Working in the supportive care unit was an immensely powerful experience. In a time of such uncertainty and fear, the chance to be physically and emotionally present for patients and their families who were coming face to face with the worst of this virus was a true honor.”

In addition to comprehensive symptom management and comfort-focused medical care, the unit supports patients and families through unique, thoughtful means. Families are encouraged to contact bedside nurses 24/7 for updates on their loved ones and can host virtual visits if loved ones are unable to come to the bedside. Led by Leah Tenenbaum, palliative care chaplain, the unit creates patient biographies which are posted at the bedside, providing structure for families to describe their loved ones, their lives, values, and what they would want to communicate to their caregivers. This helps the Supportive Care Unit tailor care for patients, and fosters connection between patients and providers, especially when patients are unable to speak for themselves. For example, learning about the music patients prefer helps provide comfort for families and patients, and in some cases obviates the need for pharmacologic therapy for agitation or delirium. The unit receives pictures from family to post at the bedside to provide comfort and familiarity, and supply handknit blankets and even fresh flowers from volunteer services for patient rooms. Through a YNHH Auxiliary grant, volunteer services provide reading materials focused on grief, loss and end-of-life care, as well as art materials and journals, for families visiting the unit.

The story of Gloria Peragine exemplifies the goals and strengths of the Supportive Care Unit at YNHH. Gloria was in a community nursing home at the beginning of the COVID pandemic. She tested positive for COVID-19 on April 22. She had been unable to have daily visits from her daughter, Teri Phillips, for several weeks due to visitor restrictions related to the pandemic. While initial symptoms were mild, her condition worsened, and she was transferred to YNHH May 3 after a fall. Teri learned of the severity of her mother’s illness and received regular communication from the time of admission to YNHH. Despite usual medical care, Gloria’s condition continued to decline, and it became clearer to her caregivers and family that she was likely nearing the end of her life. After extensive discussions with Gloria’s doctors and nurses, her family decided to focus on comfort-focused care. At that, point, Gloria was transferred to the Supportive Care Unit. Once there, Teri said, “What impressed me the most with Liz and team and, all at Yale actually, was the personal care and attention that they gave her – the fact that they asked her what kind of food she likes, what kind of music, what movies does she like? They were treating her as a patient and as a family member, rather than as someone at the end stage of her life. It was a beautiful ending to a terrible tragedy.” She added, “The best decision I ever made was to move her to Yale; […] I know the last week of her life was comfortable, that someone cared for her and went in every hour or as needed because they cared – because we could not go.” The Supportive Care Unit team met its mission by providing all-encompassing care for Gloria and her family.

In May, the Supportive Care Unit transitioned to Smilow North Pavilion 12 in the former Extended Care Clinic space under the leadership of Brianna Lutz BSN, RN, OCN, APSM, and nursing director, Tracy Carafeno MS, RN, CNML. Elizabeth Prsic, MD, director, Adult Inpatient Palliative Care and firm chief for Operations and Quality, Medical Oncology serves as the medical director of the unit with the support of Jennifer Kapo, MD, chief of Palliative Care. Thankfully, with the decline of cases in the hospital, the unit has been able to transition care to focus on the larger, COVID-19 negative patient population. The four-bed unit currently accepts COVID-19 negative patients daily 8 a.m.-5 p.m. for admission; please contact the “Supportive Care Unit SCU Covering Provider” in Mobile Heartbeat or the palliative care physician on call for referrals.

Submitted by Ruth Arnold on October 04, 2020