Criteria for a palliative care assessment at the time of admission

A potentially life-limiting or life-threatening condition and...

Primary criteria*

The "surprise question": You would not be surprised if the patient died within 12 months or before adulthood

Frequent admissions (eg, more than one admission for same condition within several months)

Admission prompted by difficult-to-control physical or psychological symptoms (eg, moderate to severe symptom intensity for more than 24 to 48 hours)

Complex care requirements (eg, functional dependency; complex home support for ventilator/antibiotics/feedings)

Decline in function, feeding intolerance, or unintended decline in weight (eg, failure to thrive)

Secondary criteria^¶

Admission from long-term care facility or medical foster home^Δ

Older patient, cognitively impaired, with acute hip fracture

Metastatic or locally advanced incurable cancer

Chronic home oxygen use^Δ

Out-of-hospital cardiac arrest

Current or past hospice program enrollee^Δ

Limited social support (eg, family stress, chronic mental illness)^Δ

No history of completing an advance care planning discussion/document

* Primary criteria are global indicators that represent the minimum that hospitals should use to screen patients at risk for unmet palliative care needs.
¶ Secondary criteria are more-specific indicators of a high likelihood of unmet palliative care needs and should be incorporated into a systems-based approach to patient identification if possible.
Δ These indicators are included based on a consensus panel opinion.

Reproduced with permission from: Weissman DE, Meier DE. Identifying patients in need of a palliative care assessment in the hospital setting. J Palliat Med 2011; 14:17. Copyright © 2011 Mary Ann Liebert, Inc.

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Criteria for a palliative care assessment at the time of admission