Background Technological, medical and public health advances in the past century have dramatically increased life expectancy in industrialised countries. The demographics of death in relation to age profile, cause of death and place of death have changed radically in that time. Sudden unexpected death is much less common than previously, with most people now dying, after a variable period of predictable decline, from chronic disease and frailty. Despite this hospital clinicians often cannot diagnose that that patient is dying, and it is often not until a clinical  deterioration occurs that clear discussions and decisions are made regarding limitation of treatment and approaching death.

Methods This presentation will discuss some approaches taken to address these issues at the Austin hospital, a large tertiary health service and university hospital in Australia. It will discuss the overlapping roles of various teams, including the rapid response team (medical emergency team), the advance care planning team, and the palliative care team, and provide practical guidance, especially in circumstances where prognosis is less clear. Some enablers and barriers, and recommendations will also be discussed briefly.

Conclusions Improvements in coordination of care near the end of life can improve outcomes for patients who die in acute hospitals. These are important concerns for the population and the health care system, given the changing demographics of death in modern societies.