This project will develop and test a novel clinical decision support tool (CDS) that encourages timely referral to palliative care for people hospitalized with heart failure. This intervention will incorporate an existing, validated 1-year mortality risk model into a CDS to deliver prognostic information and evidence-based decision support at the point of care. Thus, this research may lead to improved care-concordant and goal-directed care for people with heart failure.

Healthcare providers will encounter the tool during the routine care of their hospitalized patients. Patients randomized to the intervention arm will have providers who receive the tool and can complete one post-trial survey. High use providers will also have the opportunity to participate in a survey and 1 post-trial interview. Level 2 providers will participate in one interview.

Inclusion Criteria:

Healthcare providers must meet the following criteria:

• Are an attending physician, fellow, or resident, advanced practice nurse, or physician associate
• Has ordering privileges
• Are members of one of the hospitals' admitting teams (e.g., hospitalist service, cardiology service)
• Anticipate employment at one of the two study sites for the 15-month trial period.

Or

• Palliative care team member
• Hospital administrator/quality and safety personnel

Patients of providers enrolled in the study must meet the following criteria for heart failure during hospitalization:

• Age 18 years of age or older
• N-terminal pro-B-type natriuretic peptide values of >500 pg/ml
• Received intravenous diuretics within 24 hours of admission.

Exclusion Criteria:

• Pregnant at the time of admission.