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: Hospitalists commonly discuss advance care planning (ACP), which supports patients in understanding and expressing their values for medical care during serious illness. The coronavirus disease of 2019 (COVID-19) pandemic has increased the urgency of these conversations, especially for patients with older age, comorbidities, or an otherwise high risk for complications such as ICU admission, [...]

Background: Early palliative care can be beneficial for patients and the health system alike. The principle of palliative care is to improve quality of life through patient-centric treatment goals and comfort measures. However, many patients are identified and receive palliative care in their last days of life where hospice is more appropriate. Hospitalists are routinely [...]

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: Despite benefits of early Serious Illness Conversations (SICs), including increased satisfaction and earlier hospice referral, rates of SICs remain low. The primary aim of this study is to assess if standardized documentation of SICs increase following implementation of interventions for providers to have more of these conversations with patients admitted to a general medicine [...]

Background: Identifying patients who may benefit from a Serious Illness Conversation (SIC) in the hospital is an important step in increasing SIC timeliness. Epic’s Readmission Risk Score (RRS) is an electronic health record integrated composite score (0-100%) that includes diagnostic, laboratory, medication, order, and utilization variables to predict unplanned, 30-day readmission and was found by [...]

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: Prognostication of survival in advanced cancer patients has been challenging and contributes to poor illness understanding. Disagreements among providers about prognosis occur and is a less studied phenomenon. We asked the Surprise Question (SQ), “Would I be surprised if this patient died within the next 1 year, 6 months, and 1 month?” to Palliative [...]

Background: Patients with a pre-existing diagnosis of advanced cancer who discharge to a skilled nursing facility (SNF) after an acute care hospitalization rarely receive future oncologic treatment, have high readmission rates, and minimal hospice use. We aimed to evaluate survivorship of patients discharging to a SNF with a new diagnosis of cancer based on their [...]