Clinical Surveillance Tool to Screen for Unmet Palliative Needs Among Patients in the Final Year of Life

"Every inpatient will automatically be given the intervention (an mHOMR/HOMR Now! score) upon admission to hospital and considered for secondary interventions based on their score. Baseline threshold will be set as \>0.21 (59% sensitivity and 90% specificity for 12-month mortality with mHOMR).~At minimum each individual identified by the tool will receive two assessments to screen for severe symptoms and desire to engage in advance care planning (ACP):~1. Edmonton Symptom Assessment System Revised: scores \>6 will be flagged as severe. Clinical teams will address the symptoms as appropriate for the patient.~2. 4-item Advanced Care Planning Engagement Survey: Scores of 3-4 indicate readiness to discuss ACP. Clinical teams may choose to discuss ACP and goals of care themselves, activate a local ACP intervention, or distribute ACP documentation.~Both of these assessments will be done by a member of the treating team within 72 hours of the patient's hospital admission."