Version June 2024
| Step 1 (needs assessment): Determine if your patient has at least 1 chronic life-limiting illness: | |
| Life-limiting illness | Description |
| Advanced dementia or central nervous system disease (eg, stroke, Parkinson disease) | Assistance needed for most self-care (eg, ambulation, toileting) and/or minimally verbal |
| Advanced cancer | Metastatic or locally aggressive disease |
| End-stage kidney disease | On dialysis or serum creatinine >6 mg/dL |
| Advanced chronic obstructive pulmonary disease | Continuous home oxygen or chronic dyspnea at rest |
| Advanced heart failure | Chronic dyspnea, chest pain, or fatigue with minimal activity or rest |
| End-stage liver disease | History of recurrent ascites, gastrointestinal bleeding, or hepatic encephalopathy |
| Septic shock | Requires intensive care unit admission and has significant preexisting comorbid illness |
| High chance of accelerated death | Provider discretion, eg, hip fracture in age >80 years, major trauma in older adults (multiple rib fractures, intracranial hemorrhage), advanced AIDS |
| Step 2 (consultation): Consider a palliative care consultation if your patient has at least 1 life-limiting illness (above) AND 1 or more of the following secondary criteria: | |
| Palliative care need | Description |
| Frequent visits | 2 or more ED visits or hospitalizations in the past 6 months |
| Uncontrolled symptoms | Visit prompted by uncontrolled symptoms (eg, pain, dyspnea, depression, fatigue) |
| Functional decline | Examples: loss of mobility, frequent falls, decreased oral intake, skin breakdown |
| Uncertainty/distress | Caregiver cannot meet care needs; uncertainty or distress about goals of care |
| "Surprise" question | You wouldn’t be surprised if the patient died within 12 months; within this hospitalization |
| Death is imminent | Patient expected to die in the ED |
| Disposition planning and family requests | Family requests palliative and/or hospice care |
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