Problem: Palliative care (PC) providers at an academic medical center stated medical intensive care unit (MICU) patients are often referred late in their hospital stay, with an average PC consult rate of 65% over the last 6 months. This falls below the hospital quality performance metric of 80% of eligible patients receiving a PC consult within 48 hours of admission. Purpose: The purpose of this quality improvement (QI) project is to increase PC utilization in the MICU by implementing a nurse-driven Palliative Care Trigger Tool to prompt referral for specialty PC consults. Methods: MICU nurses and providers received education regarding underused PC services and the evidence supporting the use of nurse-driven PC trigger tools to increase PC referral. A MICU specific criteria of PC triggers was formulated by the QI implementation team based upon the best available evidence. Nursing staff were asked to screen patients daily using the PC Trigger Tool and present findings during bedside rounds. MICU providers were asked to consult PC for patients meeting trigger criteria. Rates of eligible patients and PC consults were collected via electronic medical record data reports, de-identified, and analyzed for trends via run charts. Results: Over 150 MICU nurses were educated on the PC trigger QI initiative along with 10 MICU providers, and 4 PC providers. During the 15-week project period, more than 220 patients were admitted to the MICU and an average of 91% were screened for PC triggers within 48 hours of admission. Approximately 63% of screened patients were identified as having positive PC triggers and 90% of these received a PC consult. Following implementation, the mean time for admission to consult decreased from 22.39 to 7.28 days; mean PC consultation rate within 48 hours of admission increased from 65% to 90%. Conclusion: PC consultation rates increased through the use of an evidence-based PC trigger tool, exceeding the hospital’s quality benchmark for PC referrals. Provider preference greatly impacted consultation rates and emphasizes the need to change knowledge and perspectives related to PC.