Timing of Acute Palliative Care Consultation in Critically Ill Patients

A Randomized Allocation of Palliative Care Consultation in the Emergency Department Compared to Usual Practice

A prospective randomized controlled trial studying the ordering of palliative care consultations in the emergency department (Ig) versus later palliative care consultations in the hospital--ICU or hospital ward(Cg). Patients will be randomly allocated to Ig or Cg with a 1:1 ratio.

Inclusion Criteria:

• Greater than or equal to 65 years old
• Treated in a resuscitation room for unstable vital signs or respiratory compromise
• One or more of the following:
• Advanced or metastatic solid organ cancer
• End stage organ failure of the heart, lung/COPD, kidney on dialysis, hepatic encephalopathy
• Suspected sepsis
• Advanced dementia, end-state multiple sclerosis or Parkinson's disease
• Status post cardiac arrest with coma (Glascow coma score <7)
• Patient is from a skilled nursing facility

Exclusion Criteria:

• Lack decision capacity and have no relative available during ED stay to consent to the study (legally authorized representative-LAR)
• Enrolled in hospice care prior to randomization
• A copy of a completed advance directive which names a designated proxy provided physically to the medical team prior to randomization
• Wearing a DNR bracelet
• Have been previously enrolled in this study