Modelling palliative and end-of-life resource requirements during COVID-19: implications for quality care
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Abstract
The WHO estimates that the COVID-19 pandemic has led to more than 1.3 million deaths (1 377 395) globally (as of November 2020). This surge in death necessitates identification of resource needs and relies on modelling resource and understanding anticipated surges in demand. Our aim was to develop a generic computer model that could estimate resources required for end-of-life (EoL) care delivery during the pandemic.
Setting
A discrete event simulation model was developed and used to estimate resourcing needs for a geographical area in the South West of England. While our analysis focused on the UK setting, the model is flexible to changes in demand and setting.
Participants
We used the model to estimate resourcing needs for a population of around 1 million people.
Primary and secondary outcome measures
The model predicts the per-day ‘staff’ and ‘stuff’ resourcing required to meet a given level of incoming EoL care activity.
Results
A mean of 11.97 hours of additional community nurse time, up to 33 hours of care assistant time and up to 30 hours additional care from care assistant night sits will be required per day as a result of out of hospital COVID-19 deaths based on the model prediction. Specialist palliative care demand is predicted to increase up to 19 hours per day. An additional 286 anticipatory medicine bundles per month will be necessary to alleviate physical symptoms at the EoL care for patients with COVID-19: an average additional 10.21 bundles of anticipatory medication per day. An average additional 9.35 syringe pumps could be needed to be in use per day.
Conclusions
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.
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SciScore for 10.1101/2020.07.23.20160564: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations: This model is a step change in planning for EoL care during the COVID-19 pandemic and provides detail for the stuff, staff, space and systems pandemic planning approach. It has been made freely available to enable modellers and health service funders to estimate need for EoL resource in different regions, …
SciScore for 10.1101/2020.07.23.20160564: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations: This model is a step change in planning for EoL care during the COVID-19 pandemic and provides detail for the stuff, staff, space and systems pandemic planning approach. It has been made freely available to enable modellers and health service funders to estimate need for EoL resource in different regions, countries and for different rates of disease and resource estimations for usual care. The model also highlights the gaps and opportunities for research in EoL care in the community. The work was undertaken collaboratively with health service funders, providers, clinicians and modellers to base assumptions in the reality of current practice during the pandemic. Some of the limitations of the model assumptions are limitations due to available data, rather than of the model per se. The rate of COVID-19 death in the community setting is based on the latest available figures at the time of the project, and where those for England were absent, the most geographically similar area available: Scotland, was inputted. While all deaths from COVID-19 are a tragedy, it has been postulated that between 5% and 15% of COVID-19 deaths may have occurred in people who would have died of other causes within the year.(29) However, even if this was the case and that all deaths from COVID-19 do not represent additional resource and only 85% extra is required, the increased demand of COVID-19 deaths has occurred acutely, rather than spread out over the longer time period ...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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