Palliative medicine consultation during in-center outpatient hemodialysis was well received by patients and clinical staff. Patients' symptoms were well managed at baseline by the primary nephrology team. The frequency of goals of care documentation and clarification of code status improved significantly. Embedded palliative medicine specialists on the dialysis care team may be effective in improving multidisciplinary patient-centered care for patients with end-stage renal disease.

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Increased interest among leaders and practitioners in the field of emergency preparedness in the concept of whole community resilience can create new ways reaching the community. This paper explores one approach to community-engaged preparedness education. By drawing on the fields of emergency management and simulation–based instructional design, we describe an approach to preparedness events with broad community participation. We describe the education methodology used to plan the event and the core concepts related to simulation-based education. We offer key principles for event planners to engage a diverse group of participants ranging from youth, pre-professional healthcare students, practicing healthcare professionals, and staff from local community organizations. Our experience through seven years of events offers a proof of concept available to local communities; community organizational leaders concerned with the resilience for their own organizations; and academic organizations preparing our citizens to deal with the challenges of living and serving in a world of increasing risk of disaster.

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The opioid crisis is a major concern of most health care institutions, including our large academic center. In this article, an organized approach to managing the epidemic institutionally is discussed. An Opioid Stewardship Program was instituted at our tertiary-care center with multiple sites and states of practice, which included diverse membership and expertise. Charges of the program included reviewing current practice, workflows, and external and internal guidelines and evaluating and standardizing prescribing practices. The development of an Opioid Stewardship Program resulted in:(1) an understanding of our diverse prescribing practices and the formation of patient-and procedurespecific guidelines to manage them, (2) education tools for our patients and providers, and (3) workflows and practice advisories within the electronic health record to support appropriate prescribing and monitoring of patients. This ongoing work continues to evolve in response to the needs of our patients, changing regulatory environments, and our improved understanding of our practices.