Modelling Palliative and End of Life resource requirements during COVID-19: implications for quality care

ABSTRACT                                    Background                                        There were between 84,891 and 113,139 all-cause excess deaths in the United States (US) from February 1                     st                     to 25                     th                     May 2020. These deaths are widely attributed directly and indirectly to the COVID-19 pandemic. This surge in death necessitates a matched health system response to relieve serious health related suffering at the end of life (EoL) and achieve a dignified death, through timely and appropriate expertise, medication and equipment. Identifying the human and material resource needed relies on modelling resource and understanding anticipated surges in demand.                                                                        Methods                   A Discrete Event Simulation model designed in collaboration with health service funders, health providers, clinicians and modellers in the South West of England was created to estimate the resources required during the COVID-19 pandemic to care for deaths from COVID-19 in the community for a geographical area of nearly 1 million people. While our analysis focused on the UK setting, the model is flexible to changes in demand and setting.                                                     Results                                        The model predicts that a mean of 11.97 hours (0.18 hours Standard Error (SE), up to a max of 28 hours) of additional community nurse time, up to 33 hours of care assistant time (mean 9.17 hours, 0.23 hours SE), and up to 30 hours additional care from care assistant night-sits (mean of 5.74 hours per day, 0.22 hours SE) will be required                     per day                     as a result of out of hospital COVID-19 deaths. Specialist palliative care demand is predicted to increase up to 19 hours per day (mean of 9.32 hours per day, 0.12 hours SE). An additional 286 anticipatory medicine bundles or ‘just in case’ prescriptions per month will be necessary to alleviate physical symptoms at the EoL care for patients with COVID-19: an average additional 10.21 bundles (0.06 SE) of anticipatory medication per day. An average additional 9.35 syringe pumps (0.11 SE) could be needed to be in use per day (between 1 and 20 syringe pumps).                                                                        Conclusion                   Modelling provides essential data to prepare, plan and deliver a palliative care pandemic response tailored to local work patterns and resource. The analysis for a large region in the South West of England shows the significant additional physical and human resource required to relieve suffering at the EoL as part of a pandemic response.                                                     Why Was This Study Done?                   The resource required for the relief of suffering at the EoL in the community setting has been poorly described. The stark mortality resulting from the COVID-19 pandemic has highlighted the essential requirement to better understand the demand and available supply of EoL resource to prepare, plan and deliver a palliative care pandemic response.                                                     What Did the Researchers Do and Find?                   This manuscript describes the first open access model to describe EoL resource need during COVID-19 and presents an analysis based on a UK population of nearly 1 million people. The model identified a large increase in need for staff time, including registered community nurses, health care assistants and specialist palliative care nurses and doctors, as well as pressure on resources including syringe pumps and anticipatory medication (such as opioids) used at the EoL for symptom relief from breathlessness and delirium.                                                     What Do These Findings Mean?                   The model findings are critical in planning for a second wave of COVID-19. The open-access nature of the model allows researchers to tailor their analysis to low and middle income or high-income settings worldwide. The model ensures that EoL care is not an afterthought in pandemic planning, but an opportunity to ensure that the relief of suffering at the EoL is available to all.