Nervous System Diseases

Behaviors and Mental Disorders

All Conditions

Urinary Tract, Sexual Organs, and Pregnancy Conditions

Symptoms and General Pathology

Respiratory Tract (Lung and Bronchial) Diseases

Heart and Blood Diseases

Immune System Diseases

Digestive System Diseases

Nutritional and Metabolic Diseases

Infections

Neoplasms

Skin and Connective Tissue Diseases

Rare Diseases

Dementia

Kidney Diseases

Critical Illness

Lung Diseases, Obstructive

Pulmonary Disease, Chronic Obstructive

Parkinson Disease

Heart Failure

Emergencies

Sclerosis

Multiple Sclerosis

Heart Arrest

Hepatic Encephalopathy

Sepsis

Toxemia

Multiple Organ Failure

Lung Diseases

Brain Diseases

Renal Insufficiency, Chronic

Renal Insufficiency

Parkinsonian Disorders

Ganglion Cysts

Synovial Cyst

Basal Ganglia Diseases

Central Nervous System Diseases

Movement Disorders

Synucleinopathies

Neurodegenerative Diseases

Autoimmune Diseases

Demyelinating Autoimmune Diseases, CNS

Autoimmune Diseases of the Nervous System

Demyelinating Diseases

Urologic Diseases

Urogenital Diseases

Female Urogenital Diseases

Pregnancy Complications

Female Urogenital Diseases and Pregnancy Complications

Male Urogenital Diseases

Chronic Disease

Disease Attributes

Heart Diseases

Liver Failure

Hepatic Insufficiency

Liver Diseases

Gastrointestinal Diseases

Brain Diseases, Metabolic

Metabolic Diseases

Respiratory Tract Diseases

Shock

Chronic Graft Versus Host Disease

Acute Graft Versus Host Disease

The interventional group (Ig) will have an early palliative care consultation ordered during their stay in the emergency department.

The control group will be treated as standard of care. Palliative care consultations may or may not be ordered at the attending physician's discretion.

Early order of palliative care consultation

Robert Zalenski, M.D., M.A.

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.

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

The proportion of patients who received an ACP CMS billing codes (which took effect in January 2016), in Ig vs. Cg will be evaluated using one or both of the new CPT codes for Advance care planning (ACP) services...including the explanation and discussion of advance directives such as standard forms (with the completion of such forms, when performed) by the physician or other qualified health profession; first 30 (15-45)minutes, face to face with the patients, family member(s) and/or surrogate Code 99497; and each additional 30 (46-75 minutes)-Code 99498 (Federal Register, 2015).

The investigators will align treatment preferences with medical orders, replicated as reported in the study by Mack et al. Proportions of patients coded as having a match will be compared across the treatment and control groups. For everyone who gets ACP during the study, patients or their surrogates will be asked by a member of the care team-either palliative care if they are consulted, or the hospital based care team if they are not: "If you could choose, would you prefer (a) treatment that focuses on attempting to extend your time as much as possible, even if doing so means more pain and discomfort, or (b) a plan of care that focuses on relieving pain and discomfort and improving quality of life, even though that may mean not living as long.

This outcome will be measured on a continuous scale. The net-promoter score will be measured at baseline (at randomization) and at hospital discharge for a change in value. It is measured on a scale of 1-10. Whoever signs the consent (patient of LAR) will be asked the net promoter score, and that will be reassessed by them at discharge, unless the patient has died-and the variable will then be recorded as missing. The PSQ will be administered by research assistants at the time of the patient's discharge. If the patient is incapacitated, then it will be asked of the patient's closest family caregiver. So PSQ is only at discharge of patient or available, most involved, family caregiver.

Blue Cross Blue Shield of Michigan Foundation

Wayne State University

Principle Investigator

Spots Global Cancer Trial Database for end stage chronic obstructive airways disease