Summary More than half of all UK deaths occur in hospital, yet evidence suggests that the quality of inpatient end of life care is suboptimal at best. Over half of all NHS complaints pertain to problems with care in the dying phase, particularly with regard to poor communication. This is a hugely topical area following the recent publication of the Department of Health’s End of Life Care Strategy. With reference to current literature, we seek to investigate the challenges associated with providing ‘a good death’ in hospital and construct a framework of strategies for improvement; including communication skills training, use of integrated care pathways, advance planning, educational initiatives and the role of the palliative care team.

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This series aims to help junior doctors in their daily tasks and is based on selected topics from the UK core curriculum for foundation years 1 and 2, the first two years after graduation from medical school.Every year, more than half a million people die in the United Kingdom, and over half of these deaths occur in hospital. Junior doctors are often required to care for dying patients, 1 and assessment and management of these patients are essential skills. [2][3][4] The importance of good end of life care, both for the patient and for their family, is increasingly recognised. However, many people dying in hospital continue to have unmet needs, and, in the UK more than half of complaints referred to the Healthcare Commission (the Care Quality Commission's predecessor) concerned the care of dying people. 5 Acquisition of the basic skills required to care for people who are dying can improve the patient's and their family's experience of death, as well as the safety, efficiency, and satisfaction of the junior doctor's work. PRACTICE Key pointsJunior doctors are often required to care for dying patients Early recognition of dying facilitates meeting patients' and relatives' preferences for end of life care Communication is the cornerstone of good end of life careThe principles of end of life prescribing are: to stop non-essential drugs; convert essential drugs to the subcutaneous route; and use anticipatory prescribing Cite this as: BMJ 2013;346:f2174

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