🏥 Hospital Utilization criteria ⌄
- Two or more ICU admissions within the same hospitalization
- For noncancerous disease: more than 3 hospitalizations within past 3 months related to disease exacerbation
- Pre‑existing palliative care patient
- Uncontrolled refractory symptoms (dyspnea, agitation, pain)
- Patient/family concern about course of disease or decision‑making; uncertainty regarding non‑beneficial treatment options (e.g., pressors or intubation) or considering changes in goals of care
- DNR/DNI order conflicts between patient/family and medical team
🎗️ Cancer ⌄
- Patient distress; distress thermometer score ≥ 7
- Life expectancy < 6 months (predictive indicators: spinal cord compression, brain metastasis, malignant pleural effusions, superior vena cava syndrome, hypercalcemia)
❤️ Heart Diseases ⌄
- Stage III or IV heart failure despite optimal medical management
- LVAD patient & recurrent infections
- Dyspnea with minimal to moderate exertion
🌬️ Advanced Pulmonary Disease (Advanced COPD, pulmonary fibrosis) ⌄
- Advanced lung disease with progressive functional decline and symptom burden
- Frequent exacerbations or hospitalizations despite optimal therapy
🧠 Dementia ⌄
- Totally dependent in bed on all ADLs
- Impaired swallowing/feeding problems
- Recurrent infections (more than 3 within last 3–6 months)
🧪 Liver Disease ⌄
🧠 Advanced Neurologic Diseases ⌄
- Significant functional decline in stroke, Parkinson’s disease, or traumatic brain injury (TBI)
🦠 COVID ⌄
- Patient age ≥ 75 years
- Presence of comorbidities (heart disease, diabetes, chronic lung disease, uncontrolled hypertension and/or cancer, high creatinine level or rising)
- On invasive ventilatory support > 2 weeks without clinical or biological improvement and no clear documented goals of care
- Poor performance status (bedridden, dementia, unable to perform self‑care)
🧬 Pediatric oncology patients ⌄
- Stage 4 and high‑risk neuroblastoma
- Any malignancy with poor functional status; Lansky scale < 40%
👶 Pediatric non‑oncology patients ⌄
- Neurological degenerative diseases, cerebral palsy with recurrent admissions