Table 1.

Palliative Care ICU Screening Tool and Exclusion Criteria

Item #	Screening Criteria
1	Admitted from long term skilled nursing facility or acute care facility, or admitted from home with activities of daily living dependencies requiring skilled nursing
2	End stage dementia, amyotrophic lateral sclerosis, Parkinson’s disease, or multiple sclerosis
3	Advanced or metastatic cancer
4	Cardiac or respiratory arrest with neurological compromise
5	Multiple organ system failure
6	Known end-stage organ disease including cirrhosis, renal disease on dialysis, NYHA Class III or IV heart failure, or COPD on home oxygen
7	Acute shock requiring at least six hours of vasopressors or inotropic support
8	Acute respiratory failure requiring mask ventilation or intubation
9	Hospital stay greater than five days or ICU readmission for the same diagnosis within thirty days
	Exclusion Criteria
1	History of any stem cell transplant
2	Solid organ transplant within 1 year of transplant, or actively undergoing work-up for solid organ transplant
3	Non-English speaking patients for whom an interpreter was unavailable
4	Patients without capacity to participate in palliative care discussions with no identifiable surrogate
5	Patients who refused to had a surrogate refuse palliative care consultation
6	Patients who had received a palliative care consultation earlier during the same hospitalization
7	Patients already determined to be do-not-resuscitate/do-not-intubate