ABSTRACT
Objectives: The ED serves as a frequent interface for patients approaching end-of-life (EoL), with up to 75% of patients experiencing an emergency department (ED) visit in the last 6 months of life. Hospice care in the last 6 months is associated with improved patient experience, care satisfaction, and pain control. Earlier hospice enrollment also improves resource utilization by reducing hospital length of stay and readmissions. During the COVID-19 pandemic, our ED experienced an increased number of EoL patients receiving care in hallway beds while awaiting hospital admission or transfer to hospice care. Lack of patient privacy and limited prior training on caring for EoL patients contributed to the moral distress experienced by nurses, physicians, patients and families. To address this, we implemented and evaluated a hospice ED observation pathway (HEDOP) for EoL patients transitioning to comfort-focused care in the ED setting. Design/Methods: A HEDOP was developed to guide treatment for EoL patients transitioning to comfort-focused care during the ED course. The pathway identified the appropriate patient population with inclusion/exclusion criteria (Table 1). A 'comfort measures' order set provided quick access to medication orders for common EoL symptoms such as dyspnea and pain, spiritual care and social work consultation. The ED observation unit is staffed by ED registered nurses and Advanced Practice Providers, with emergency physician support. To provide EoL education, we offered didactic lectures, bedside teaching from a palliative medicine fellow, and the opportunity to shadow providers at a local hospice facility. Results/Findings: Over a 1-year period (January 2021-22), 38 patients were cared for using the HEDOP. Mean age was 77 years (range 43-102 years). Mean ED length of stay (including observation status) was 20 hours (range 3-49 hours). Patient disposition from the HEDOP was as follows: 29% home with hospice, 47% inpatient hospice facility, and 21% died during the observation stay. In addition to clinical EoL care and symptom management, 47% of patients received spiritual care and 97% had a social worker involved in their care. Conclusion(s): To our knowledge, this is the first use of an ED observation protocol for hospice initiation in the US. Implementation of a HEDOP offered patients and families earlier access to hospice care from the ED. Providers reported being better equipped to provide care and tailored support for EoL patients. All but one patient avoided hospital admission;the majority were discharged to home or inpatient hospice. A HEDOP provides opportunity to help patients access hospice care from the ED, facilitates disposition from the ED to home or inpatient hospice, and receive quality EoL care while in the ED. Future studies should assess patient and family satisfaction with care received under an ED HEDOP. [Formula presented] No, authors do not have interests to disclose Copyright © 2022
ABSTRACT
The objective of this study was to test the effectiveness of ivermectin for the treatment of mouse hepatitis virus (MHV), a type 2 family RNA coronavirus similar to SARS-CoV-2. Female BALB/cJ mice were infected with 6,000 PFU of MHV-A59 (group infected, n = 20) or infected and then immediately treated with a single dose of 500 µg/kg ivermectin (group infected + IVM, n = 20) or were not infected and treated with PBS (control group, n = 16). Five days after infection/treatment, the mice were euthanized and the tissues were sampled to assess their general health status and infection levels. Overall, the results demonstrated that viral infection induced typical MHV-caused disease, with the livers showing severe hepatocellular necrosis surrounded by a severe lymphoplasmacytic inflammatory infiltration associated with a high hepatic viral load (52,158 AU), while mice treated with ivermectin showed a better health status with a lower viral load (23,192 AU; p < 0.05), with only a few having histopathological liver damage (p < 0.05). No significant differences were found between the group infected + IVM and control group mice (P = NS). Furthermore, serum transaminase levels (aspartate aminotransferase and alanine aminotransferase) were significantly lower in the treated mice than in the infected animals. In conclusion, ivermectin diminished the MHV viral load and disease in the mice, being a useful model for further understanding this therapy against coronavirus diseases.