Background: Studies have shown that for patients with advanced cancer, integration of Palliative Care (PC) is associated with improved symptom control, clearer understanding of prognosis, lower utilization of health care resources, and increased hospice use. The 2012 ASCO guidelines call for incorporation of PC for any patient with metastatic cancer and/or high symptom burden. Despite a top-rated PC division at Mount Sinai, our Solid Tumor (ST) Division utilized PC and hospice less than other centers. Our inpatient ST service demonstrated poor quality metrics. Our 2011-2012 UHC statistics were: mortality index, 1.35 (target <1), 30-day readmission rate, 21.7%, (target < 10.3%) and length of stay (LOS) index, 1.23 (target <1). We hypothesized that implementing standardized criteria for PC consultation would improve these metrics. Methods: During this 3-month pilot, criteria for PC consultation included patients with one or more of the following: stage IV disease, Stage III lung or pancreatic cancer, hospitalization within prior 30 days, >7 day hospitalization, uncontrolled symptoms (pain, nausea, dyspnea, delirium, distress). We looked at two baseline groups for comparison: 1) patients who met eligibility in a six week period prior to the intervention 2) For UHC index data, we used the hospital dashboard average over a 1-year period prior to the intervention. Primary outcomes were: hospice utilization, ST mortality index, 30-day readmission rate and LOS. Results: Comparing group 1 to the pilot group, palliative care consultation doubled from 41% to 82%, 30-day readmission decreased from 36% to 17% (p = 0.022), and hospice utilization increased from 14% to 25% (p = 0.146). UHC data (Group 2 vs. Pilot) showed: mortality index improved (1.35 to 0.59) and 30-day readmission rates decreased (21.7% to 13.5%, p = 0.026). LOS was unchanged (1.23 to 1.25). Conclusions: Mandating palliative care consults for patients at the highest risk for in hospital death and readmission improved hospice utilization, 30-day readmission, oncology service mortality and adherence with ASCO guidelines. Mount Sinai has funded an extra palliative care team; use of these criteria have become our standard of care.