Background: Cardiac arrest on the wards may be preceded by unmet palliative care needs, including advance care planning and specialty palliative consultation that can seek to align patients’ prognoses and goals for care. Identification of hospitalized patients with limited life expectancy allows for the delivery of appropriate palliative interventions. However, the prognosis on admission of [...]

Background: Code status discussions often link do-not-intubate (DNI) orders with do-not-resuscitate (DNR) orders, although cardiac arrest accounts for less than 2% of endotracheal intubations. DNR orders are more commonly implemented for older patients with more comorbid conditions regardless of the reason for hospitalization, and are associated with withholding treatments outside of the cardiac arrest setting. [...]

Background: In 2011, sepsis accounted for more than $20 billion (5.2%) of total US hospital costs.  The CDC estimates that hospitalizations for sepsis or septicemia increased from 621,000 to 1,141,000 in 2000 and 2008 respectively.  Severe sepsis has an in-hospital mortality rate of 28.6-37.7%, and those who survive may face a difficult recovery including long-term [...]

Background: Hospitalization of the patient with advanced cancer can be a pivotal moment and opportunity to explore patient goals of care in order to deliver high value, patient-centered care that emphasizes quality of life. Part of this discussion should define patient preferences regarding code status as it is known that prognosis is extremely poor and [...]

Background: Prognostication of survival in advanced cancer patients has been challenging and contributes to poor illness understanding.  Prognostic disagreement occurs even amongst providers and is a less studied phenomenon.  We introduced the Surprise Question (SQ), “Would I be surprised if this patient died in the next 1 year, 6 months, and 1 month?”, at multidisciplinary [...]

Background: Reducing LOS promotes value, and when aligned with patient preferences, can improve care. Patients referred for palliative care (PC) generally have longer length of stay (LOS) due to their serious illness, multiple complex management issues, and the fact that long LOS is a reason for engaging a specialty PC team. The aim of this [...]