Improving the quality of care in patients with COVID-19

BACKGROUND During the COVID-19 pandemic, the urgent need for advance care planning (ACP) and cognitive evaluations in older adults intensified As reports of cognitive changes in younger adults also emerged, it became evident that efforts to complete ACPs and cognitive assessments were important regardless of age In response, the South Texas Veterans Health Care System, enacted a clinical initiative with the aim of completing these evaluations in all enrolled Veterans with COVID- 19 prior to potential admission Method In this initiative, geriatricians, palliative care physicians, and fellows attempted to call all Veterans diagnosed with COVID-19 to discuss ACP and perform cognitive screening ACP was documented in Life Sustaining Treatment (LST) notes, and Veterans without Advance Directives (AD) on file were sent AD forms to complete by mail Cognitive screenings included the Telephone Executive ASessment (TEXAS) and AD8 that were documented in a COVID- 19 Mental Status Note (CMSN) Programmatic evaluation is being conducted via chart review for presence of LST notes, AD, and CMSN for all Veterans before and after COVID-19 diagnosis Results Between the dates of March 22 and July 20, 2020, there were 500 veterans diagnosed with COVID-19, all of whom were included in this initiative Before the initiative, 11 had LST notes and 86 had Advanced Directives (AD) After the initiative, 359 veterans completed LST notes (increase of 3163%), and 118 had AD completed A total of 182 cognitive screenings were completed Of those, 28 screened positive for cognitive impairment Discussion This program greatly increased the number of COVID-19 positive veterans who had ACP discussions and baseline cognitive assessments It's limitations include patient availability and willingness to participate, clinician time, and ability to follow-up on AD paperwork and repeat cognitive screens Ongoing analysis and future directions include program continuation, determining the number of Veterans admitted following ACP completion and following-up on AD paperwork and repeat cognitive screening By increasing ACP and cognitive screening prior to admission this program has the potential to positively impact Veterans and care teams throughout the pandemic