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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

Diseases and Abnormalities at or Before Birth

Gland and Hormone Related Diseases

Hypertension

Syndrome

Congenital Abnormalities

Liver Neoplasms

Hypertension, Pulmonary

Insulin Resistance

Hypoglycemia

Vascular Malformations

Hyperandrogenism

Hyperinsulinism

Hyperammonemia

Hepatopulmonary Syndrome

Hypoglycemic Agents

All Drugs and Chemicals

Hematinics

Insulin

Insulin, Globin Zinc

Liver Extracts

Consist in spontaneous, surgical or interventional closure of the shunt. Depending on context, surgical intervention may also be transplantation.

Shunt Closure

Valérie A Mc Lin, Prof. Dr. med.

Congenital Portosystemic Shunt (CPSS) is a rare condition important by the multiplicity and severity of associated complications.

CPSS is venous anomaly in which blood coming from the intestines only partially passes through the liver.

This leads to the accumulation of potentially toxic factors that cause systemic effects.

Complications vary among the individuals, and currently, it is challenging to predict which individuals will develop severe complications.

The IRCPSS registry is established with the aim of centralizing detailed clinical follow-up and biological information from participants around the world who suffer from Congenital Portosystemic Shunt (CPSS). A multidisciplinary consortium of experts is collaborating to enhance our understanding of the prevalence, natural history, individual risks, and physiopathology of the disease through the IRCPSS registry.

International Registry of Congenital Portosystemic Shunt (IRCPSS)

International Registry of Congenital Portosystemic Shunts (IRCPSS) - A Multi-centre, Retrospective and Prospective Registry of Neonates, Children and Adults With Congenital Portosystemic Shunts

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Timing of Acute Palliative Care Consultation in Critically Ill Patients	NCT02858778	Multiple Organ ... End Stage Cardi... End Stage Chron... Chronic Kidney ... Hepatic Encepha... Sepsis Dementia Multiple Sclero... Parkinson's Dis... In-Hospital Car... Solid Organ Can...	Early order of ...	65 Years -	Wayne State University
International Registry of Congenital Portosystemic Shunt (IRCPSS)	NCT06041906	Congenital Port...	Shunt Closure	1 Day -	University Hospital, Geneva
International Registry of Congenital Portosystemic Shunt (IRCPSS)	NCT06041906	Congenital Port...	Shunt Closure	1 Day -	University Hospital, Geneva

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