Center to Advance Palliative Care

The concept of a rapid response team member initiating a "STAT" palliative care conversation while a patient is in extremis is fascinating. We frequently struggle with this with about 30% of our rapid response calls resulting in palliative care consultation. Reports range from 10-50%. This may explain why the institution of a rapid response process does NOT impact on hospital mortality since many of the patients for whom a rapid response is called, are dying from terminal disease and would die, with or without life sustaining interventions. When I am the ICU attending, my rapid response pager and palliative care pager go off simultaneously. We are now training our second year residents how to have a “STAT Goals of Care Discussion” during a rapid response. They do not have the skills and simply panic, code the patient and send them to the ICU because it is easier and they are less likely to “get in trouble” from the attending of record.