Patient Inclusion Criteria  Admitted to a participating study ICU Age greater than or equal to 60 years Meets one or more of the following acute or chronic triggers for PC consultation  Acute:  Cardiac or respiratory arrest with coma1 Ischemic or hemorrhagic stroke requiring mechanical ventilation ICU admission after hospital stay of greater than or equal to 10 days or ICU readmission within 30 days Age greater than or equal to 80 and 1 or more forms of organ support2 Multiorgan system failure3 CCM physician judgment of greater than or equal to 50% risk of in-hospital death or new severe long term functional impairment  Chronic:  Admission from a SNF or LTACH with progressive functional decline Metastatic (stage IV) cancer or advanced cancer without curative treatment End stage cardiorespiratory disease End stage liver disease4 Advanced dementia or other end-stage neurologic disease Age greater than or equal to 80 with two or more major comorbidities5  Moderate-severe frailty (excluding stable intellectual or physical disability 6  Pittsburgh Cardiac Arrest Category (PCAC) greater than or equal to 2 Organ support: RRT, invasive or non-invasive mechanical ventilation, vasopressors Sequential Organ Failure Assessment (SOFA) score greater than or equal to 10 Model for End-Stage Liver Disease (MELD) greater than or equal to 30 Major comorbidities defined by Charlson Co-morbidity Index (CCI) Clinical Frailty Scale (CFS) score greater than or equal to 6  Patient Exclusion  No surrogate decision maker Already received (or refused) a Palliative Care consultation during the same hospitalization Determined to be imminently dying (within hours) by CCM physician Within 1 year of receiving organ transplant, or actively undergoing work-up for organ transplant Non-English speaking  Surrogate Inclusion  Primary surrogate, as determined by the patient's advance directive or by the hierarchy codified in state law Up to 3 additional surrogates  Surrogate Exclusion  Age <18 Cannot read or understand English Cannot complete surveys due to physical or cognitive limitations  Clinician Inclusion  •Patient's primary attending (or their designee)