In a large pediatric tertiary care hospital, a CPG was successfully deployed. CPGs can favorably affect the use rates and costs of parenteral nutrition.

Often thought of as a benign and self-limited condition, hiccups can become persistent or intractable, and thus be associated with substantial morbidity and distress. In such cases, an underlying etiology is often present, and may be overlooked. Debilitating hiccups can present a major challenge to optimal symptom management. Various causes of protracted hiccups have been identified including metabolic abnormalities, central nervous system pathology, malignancy, medications, and disorders attributed to cardiac, pulmonary and gastrointestinal etiologies. We present a case of intractable hiccups in a patient with an advanced hematological malignancy and review specific therapies for the management of persistent hiccups.

Objectives 1. Understand the specific palliative care consultation needs of patients in the emergency department. 2. Understand the specific needs of the emergency clinicians who request palliative care consults in the emergency department. 3. Describe the expectations, ''What should palliative care clinicians expect to provide when they are called for an emergency-department-initiated-palliative-care-consult?'' Background. Palliative specialists are interested in moving services upstream to the emergency department (ED) in order to enhance earlygoal-directed-patient-centered-care. ED-care is geared towards the acutely ill/injured with often ill-defined-disease-trajectories. ED Palliative-care (PC) service needs may therefore be different from the traditional-in-patient-PCC model (TIP-PCC). Research Objectives. We study ED-Initiated-PCconsults (EDI-PCC) to characterize/compare the PC needs of ED patients/clinicians with TIP-PCC. Method. Descriptive analyses of PC team consults (3/2008-6/2009) in an urban, level-1 Trauma-Center. PC team comprises of; 2 advanced-nursepractitioners, 2 masters-trained bereavement counselors, social-workers and volunteer-clergy.

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