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.
Greater than or equal to 65 years old Treated in a resuscitation room for unstable vital signs or respiratory compromise One or more of the following: Advanced or metastatic solid organ cancer End stage organ failure of the heart, lung/COPD, kidney on dialysis, hepatic encephalopathy Suspected sepsis Advanced dementia, end-state multiple sclerosis or Parkinson's disease Status post cardiac arrest with coma (Glascow coma score <7) Patient is from a skilled nursing facility
Exclusion Criteria:
Lack decision capacity and have no relative available during ED stay to consent to the study (legally authorized representative-LAR) Enrolled in hospice care prior to randomization A copy of a completed advance directive which names a designated proxy provided physically to the medical team prior to randomization Wearing a DNR bracelet Have been previously enrolled in this study
