NEEDS-PC Trial: Promoting Access to Inpatient Palliative Care

Palliative care is specialized medical care for individuals of any age with any serious illness that seeks to improve quality of life by relieving physical and psychological symptoms, and emotional and spiritual distress, and ensuring care is aligned with their goals.

The goal of hospice care is similar to palliative care but it is reserved for patients nearing the end of life who choose  to focus on their comfort and forego curative or life-prolonging treatments. In contrast, palliative care is appropriate for individuals with a serious illness at any stage or treatment intent.

Palliative care benefits patients with an acute and/or chronic serious illness and (i) uncontrolled physical or psychological symptoms; (ii) emotional, social, or spiritual needs; (iii) serious illness communication needs (e.g., prognostic sharing, eliciting goals, values, and treatment preferences); and (iv) navigating complex medical decision-making.

To promote evidence-based delivery of inpatient palliative care for hospitalized adults with any serious illness (at any stage and treatment intent) and unmet palliative care needs to improve the patient-centeredness, quality, and outcomes of care.

Hospitalized patients ≥18 years of age with ≥1 acute or chronic serious illness and unmet palliative care needs documented during the hospital stay. Patients on the following inpatient services will be excluded from the study: observation, rehabilitation or SNF, psychiatry or addiction, obstetrics and neonatal.

Electronic health record data are evaluated in real-time during the hospital stay to identify patients with serious illness and multiple unmet palliative care needs such as uncontrolled pain or symptoms, recent acute care utilization, frailty, and functional or cognitive impairment.+ What happens after eligible patients are identified?

A study alert recommending inpatient palliative care consultation will fire (7A-7P) for the patient’s primary attending physician when they open the chart. If other providers (house staff, nurse practitioners, and physician assistants) are designated to a primary team role in the patient’s chart, they will also receive a study alert.

A study alert recommending inpatient palliative care consultation will fire (7A-7P) for the patient’s primary attending physician when they open the chart. If other providers (house staff, nurse practitioners, and physician assistants) are designated to a primary team role in the patient’s chart, they will also receive a study alert.

No. The EHR algorithm to identify patients with unmet palliative care needs was refined in 2024-2025 to increase their likelihood of benefitting from an inpatient palliative care consultation. The two alerts being tested in this study differ from other palliative care alerts you may have received previously.

MedStar Health is proud to partner with the University of Pennsylvania Palliative Advanced Illness Research (PAIR) Center on this study. As a system, we are committed to providing  excellent care to every patient we see and using science and research to advance our work to being the trusted healthcare leader for our communities. For those with serious illness, palliative care can provide healing benefits and improve outcomes. Unfortunately, too many patients who could benefit from palliative care receive it too late or not at all. Studies like the NEEDS-PC Trial help us better understand barriers and test potential solutions to increasing access to the healing therapies of our palliative care teams. 

MedStar Harbor Hospital

MedStar Franklin Square Medical Center

MedStar Montgomery Medical Center

MedStar Washington Hospital Center

MedStar St. Mary’s Hospital

MedStar Georgetown University Hospital

MedStar Good Samaritan Hospital

MedStar Union Memorial Hospital

MedStar Southern Maryland Hospital Center

We expect to share initial results in 2027-2028. 

You will be prompted to order a palliative care consult, request a reminder 24 hours later, or dismiss the alert. If you are not the patient’s primary attending or a provider on the primary inpatient team, you may indicate that in the alert.

Yes. Throughout the study, any provider can order a palliative care consult for any patient at any time.

The alert should not fire for a patient if they have already received a palliative care or hospice consult during the hospitalization.

It is appropriate to order an inpatient consult to facilitate coordination of palliative care services during transitions in care across healthcare settings. 

No. All palliative care consults orders should be handled as the team usually would.

This study is evaluating the effectiveness of different ways to promote evidence-based delivery of inpatient palliative care. Therefore, increases in consult volume are an expected part of the study, though this may vary by hospital and over time. Palliative care teams are expected to handle busy consult days during the study as they usually would.  The advanced care planning team staff will continue to be available to assist with completing inpatient palliative care consults as needed.

Yes. Any consult will continue to populate in the CORES list.

It is likely that patient will still benefit from an inpatient palliative care consult. Contact the primary team to confirm.

Cancel the duplicate order or ask the primary team to do so and proceed with the consult.