1. Utilizing a case-based approach, participants will self-report the ability to evaluate the merits and potential drawbacks of providing telepalliative care in the rural emergency department setting. 2. Utilizing an evidence-based approach, participants will self-report the ability to synthesize a rationale for clarifying goals of care in the emergency department prior to potential patient transfer to a higher level of care. Critically ill patients who present to rural emergency departments are often transferred far from home to quaternary medical centers for interventions that may or may not align with their goals of care. A telepalliative care consultation prior to potential transfer opens an alternative pathway to provide patient-centered goal-concordant care that positively impacts patients, families, clinicians, and health systems. Background: Specialty palliative care is prevalent in urban and academic settings, however in rural areas, access to this care is limited and the population faces a higher probability of serious illness. Disparities and misalignment between patient values, preferences, and plan of care often results in patient transfer from rural facilities to quaternary medical centers for low-value, goal-discordant care. Mr. J was a 90-year-old African American man with inclusion body myositis (bedbound), chronic respiratory failure, and increasingly frequent hospitalizations who presented to a rural hospital near his home critically ill from congestive heart failure. A goals of care (GOC) discussion between the emergency department clinician and family resulted in a request to "have everything done" to save his life. Triggered by a machine-learning algorithm (SafeNET), a "TeleGOC Pause" (clinician premeeting, telepalliative consultation, and recommendations) was performed. During the consultation, the patient's wife and daughter shared, "He wants to live, who doesn't?", and that he was afraid to die. The telepalliative clinician shared that Mr. J's body was dying, and that time may be short. Recalling his heart being shocked during a previous admission, his family wanted to avoid such interventions and hoped to get him back home. A recommendation was made for DNR/DNI and home hospice care. They agreed, the transfer was canceled, and he was admitted locally for diuresis overnight to improve symptoms before being discharged home with hospice the following day. Mr. J lived with his family for another 2 weeks. Telepalliative care in the emergency department aligns patient values and care preferences with a goal-concordant care plan, addresses disparities in care, and can avoid goal-discordant transfers away from a patient's home community. This service opens an alternative care pathway that positively impacts patients, families, and clinicians while providing substantial potential cost savings for health systems. Models of Palliative Care Delivery; Innovative Technologies [ABSTRACT FROM AUTHOR]