Admission Surprise Question Response and Its Association with Advance Care Planning Documentation and Palliative Care Consultation: A Multisite Propensity-Matched Cohort Study

Background: The Surprise Question (SQ) asks providers, “Would you be surprised if this patient died in the next year?”. It is a tool that was developed to help providers identify patients who would benefit from palliative care (PC) interventions. There is limited research on whether the provider’s response to the SQ at the time of hospital admission influences the quality of care and clinical outcomes in the inpatient setting. Aim: To evaluate the impact of the SQ response at the time of hospital admission on the initiation and timing of PC interventions during hospitalization. Design: This was a retrospective, propensity-matched cohort study assessing the association between the SQ response and the presence and timing of advance care planning (ACP) documentation and PC consultation. Setting/Participants: The study included hospitalized patients admitted to the Hospital Medicine service across three New York University Langone Health sites in New York City over a five-year period (2020–2025) with a discharge disposition of “expired” or discharged to hospice care (inpatient or outpatient). Results: After propensity matching, 8,970 encounters were analyzed. Patients with an SQ response of “No” on admission had higher odds of having ACP documentation or PC consultation (odds ratio 1.28, 95% confidence interval [CI]: 1.11–1.49) compared to those with a response of “Yes.” In addition, patients with a “No” response had ACP documentation or PC consultation an average of 2.7 days earlier than those with a “Yes” response (CI −2.9 to −2.5, p < 0.001). Conclusions: An SQ response of “No” at the time of admission was associated with an increased likelihood and earlier timing of PC interventions.