COVID-19 e cure palliative: l'impatto della pandemia sull'erogazione delle cure palliative a pazienti non COVID

[Autom. eng. transl.] PURPOSE: Palliative care can play a crucial role during a pandemic. The repercussions of the COVID-19 pandemic have been felt not only on COVID patients susceptible to Palliative Care, but also on all other complex patients who have not contracted the infection. The population of patients susceptible to Palliative Care has changed in relation to the time considered (pre-lockdown, lockdown and post-lockdown). This study aims to analyze whether and to what extent the provision of Palliative Care to non-COVID patients has changed during the COVID-19 pandemic, in the context of a University Hospital. METHOD: To study how the COVID-19 pandemic influenced the activity of intra-hospital Palliative Care, patients admitted from 1 October 2019 to 30 September 2020 assessed by the Palliative Care team were examined. This period was divided as follows: - Pre-lockdown (period 1): from 1 October 2019 to 31 January 2020 - Lockdown (period 2): from 1 February 2020 to 31 May 2020 - Post-lockdown (period 3): from 1 June 2020 to 30 September 2020. For each of these periods the following were studied: - number of hospitalized patients - age - type - diagnosis (oncological versus non-oncological) - length of stay - number of patients who died during hospitalization - latency time for activation of Palliative Care: - length of stay after Palliative Care consultancy - average number of Palliative Care consultations per patient. - home discharge vs hospice discharge. RESULTS: The trend in the number of hospitalized patients for whom a Palliative Care evaluation was requested was analysed, with evidence of a statistically significant positive linear trend. The number of patients studied was 1168. The number of Palliative Care consultations was 1482. Of the 1168 patients, 264 died. The discharge method is known for 883 patients: 454 in home palliative care (53.22%) and 399 in hospice (46.78%). Stratifying the data over the three periods the following results are obtained. In pre-lockdown: 110 patients in home palliative care (55.47%) vs 147 patients in hospice (44.53%). In the lockdown: 160 patients in home palliative care (43.26%) vs 122 patients in hospice (56.74%). Post-lockdown: 184 patients in home palliative care (41.40%) vs 130 patients in hospice (58.60%). The activity of the Palliative Care team increased in the period considered. During the lockdown, the population assessed by the Palliative Care team was older than pre-lockdown. This could be attributed to a "selection effect" of young patients, who remained at home, avoiding the risk of contagion to which they would have subjected themselves by going to hospital. The length of stay was reduced both during lockdown and post-lockdown. This variable is determined by the latency for the activation of Palliative Care (which depends on the efficiency of the doctors in the hospital departments) and by the time from the activation of Palliative Care to the patient's discharge or death (which depends on the efficiency of the Palliative Care team and the availability of the territory). The latency time for the activation of Palliative Care decreased in the post-lockdown, compared to pre-lockdown. This could be due to a greater efficiency of doctors in hospital departments, due to the greater load of hospital patients. The length of stay after the activation of Palliative Care decreased both in the lockdown and in the post-lockdown period. This could be attributable to a greater availability, in terms of free beds, of the territory to welcome patients, and to a greater "discharge push" on the part of the hospital departments, due to the increase in