Using the Surprise Question To Identify Those with Unmet Palliative Care Needs in Emergency and Inpatient Settings:...

Area of Science:

• Palliative Care
• Medical Decision Making
• Healthcare Quality Improvement

Background:

• The surprise question (SQ) effectively identifies patients with end-stage renal disease and cancer at high risk of mortality.
• Implementation of the SQ in acute care settings aims to address potential unmet palliative care needs.

Purpose of the Study:

• Evaluate hospital-based providers' perceptions of the SQ's feasibility in emergency and inpatient settings.
• Assess clinician perceptions of the SQ's utility and identify barriers to its use.

Main Methods:

• A cross-sectional survey was conducted among medical providers after integrating the SQ into the electronic health record.
• The survey targeted providers in a tertiary care hospital setting.

Main Results:

• 55% of providers participated; 84% were emergency physicians and 43% were inpatient providers.
• Most providers found the SQ feasible and reported it influenced care delivery, goals of care, and advance care planning discussions.
• A significant barrier identified was provider concern regarding the accuracy of SQ responses (55%).

Conclusions:

• Clinicians perceive the SQ as feasible, acceptable, and useful for initiating advance care planning discussions.
• While the SQ influences goals of care, concerns about its accuracy require further research.
• Additional studies are warranted to examine the SQ's accuracy and predictive capabilities.