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This was a retrospective cohort study, carried out at a large university-associated ICU in Melbourne, Australia, and was conducted on adult patients aged at least 18 years admitted to ICU between July 2019 and July 2023. The study included 11,449 ICU admission episodes relating to 10,171 patients. The overall ICU mortality for all patients was 9% in ICU with a further 4.3% post-ICU. Within non-survivors, specialist palliative care involvement was uncommon for patients who died in ICU (78\/1035, 7.5%), but substantial (287\/488, 59%) for those ICU patients who died on a hospital ward after ICU discharge. Compared with ICU patients who did not have an identified palliative care referral, ICU patients with palliative care input averaged longer ICU stays with shorter hospital stays post-ICU discharge. The referral tool showed low sensitivity (39%) when compared with observed current ICU palliative care referral practice. Clinical staff within the ICU provided the majority of palliative care for ICU patients, with a palliative care consultative service taking a proportionally much greater role in post-ICU hospital wards. The selected criteria appeared inadequate for use as an effective referral tool. 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