Presence of a Serious, Chronic Illness

• Declining ability to complete activities of daily living
• Weight loss
• Multiple hospitalizations
• Difficult to control physical or emotional symptoms related to serious medical illness
• Patient, family or physician uncertainty regarding prognosis
• Patient, family or physician uncertainty regarding goals of care
• Patient or family requests for futile care
• DNR order conflicts
• Use of tube feeding or TPN in cognitively impaired or seriously ill patients
• Limited social support and a serious illness (e.g., homeless, chronic mental illness)
• Patient, family or physician request for information regarding hospice appropriateness
• Patient or family psychological or spiritual distress

Oncology Criteria

• Metastatic or locally advanced cancer progressing despite systemic treatments with or without weight loss and functional decline;
  • Progressive brain metastases following radiation
  • New spinal cord compression or neoplastic meningitis
  • Malignant hypercalcemia
  • Progressive pleural/peritoneal or pericardial effusions
  • Failure of first – or second-line chemotherapy
  • Multiple painful bone metastases
  • Consideration of interventional pain management procedures
  • Severe prolonged pancytopenia in the setting of an untreatable hematological problem (e.g., relapsed
    leukemia)

Emergency Department Criteria

• Multiple recent prior hospitalizations with same symptoms/problems
• Long-term-care patient with Do Not Resuscitate (DNR) and/or Comfort Care (CC) orders
• Patient previously enrolled in a home or residential hospice program
• Patient/caregiver/physician desires hospice but has not been referred
• Consideration of ICU admission and or mechanical ventilation in a patient
  • with metastatic cancer and declining function
  • with moderate to severe dementia
  • with one or more chronic diseases and poor functional status at baseline

Intensive Care Unit Criteria

• Admission from a nursing home in the setting of one or more chronic life-limiting conditions (e.g., dementia)
• Two or more ICU admissions within the same hospitalization
• Prolonged or difficult ventilator withdrawal
• Multi-organ failure
• Consideration of ventilator withdrawal with expected death
• Metastatic cancer
• Anoxic encephalopathy
• Consideration of patient transfer to a long-term ventilator facility
• Family distress impairing surrogate decision making

Source: www.getpalliative.com