84 patients were included in the study, 40.5% (34 patients) of whom had a synchronous new diagnosis of cancer and Bmets.  97.6% of patients (n=82) were admitted (69.5% to medicine, 20.7% neurosurgery, 6.1% neurology, and 3.6% critical care).  Average length of stay was 6.6 days (SD 4.9), with 11.92 hours (SD 6.85) in the ED. Overall survival after diagnosis averaged 448 days (SD 686). 19.2% died within 30 days, and 17.8% required unexpected readmission.  Nearly half (48.8%) of patients saw palliative care during their initial admission.  Patients who were seen by palliative care were more likely to have higher uRPA classifications (p=.02) and longer length of stay inpatient (p=.02). These patients were less likely to undergo any treatment (p=.00) and more likely to be discharged on hospice (p=.00). They were not more likely to have advanced directives documented (p=.33). They were not more likely to die (p=.32) or be readmitted (p=.08) within 30 days despite having a shorter overall survival (248 days versus 585 days (p=.02)).