Integrated Supportive and Palliative Care for Older Adults in the ICU

You may be eligible if

• 1. Admitted to a participating study ICU
• 2. Age greater than or equal to 60 years
• 3. Meets one or more of the following acute or chronic triggers for PC consultation
• Acute:
• Cardiac or respiratory arrest with coma
• Ischemic or hemorrhagic stroke requiring mechanical ventilation
• ICU admission after hospital stay of greater than or equal to 10 days or ICU readmission within 30 days
• Age greater than or equal to 80 and 1 or more forms of organ support
• Multiorgan system failure
• CCM physician judgment of greater than or equal to 50% risk of in-hospital death or new severe long term functional impairment
• Chronic:
• Admission from a SNF or LTACH with progressive functional decline
• Metastatic (stage IV) cancer or advanced cancer without curative treatment
• End stage cardiorespiratory disease
• End stage liver disease
• Advanced dementia or other end-stage neurologic disease
• Age greater than or equal to 80 with two or more major comorbidities
• Moderate-severe frailty (excluding stable intellectual or physical disability
• 1. Pittsburgh Cardiac Arrest Category (PCAC) greater than or equal to 2
• 2. Organ support: RRT, invasive or non-invasive mechanical ventilation, vasopressors
• 3. Sequential Organ Failure Assessment (SOFA) score greater than or equal to 10
• 4. Model for End-Stage Liver Disease (MELD) greater than or equal to 30
• 5. Major comorbidities defined by Charlson Co-morbidity Index (CCI)
• 6. Clinical Frailty Scale (CFS) score greater than or equal to 6
• Patient Exclusion
• No surrogate decision maker
• Already received (or refused) a Palliative Care consultation during the same hospitalization
• Determined to be imminently dying (within hours) by CCM physician
• Within 1 year of receiving organ transplant, or actively undergoing work-up for organ transplant
• Non-English speaking
• Surrogate Inclusion
• Primary surrogate, as determined by the patient's advance directive or by the hierarchy codified in state law
• Up to 3 additional surrogates
• Surrogate Exclusion
• Age \<18
• Cannot read or understand English
• Cannot complete surveys due to physical or cognitive limitations
• Clinician Inclusion
• Patient's primary attending (or their designee)