Physicians often encounter periods of unexplained higher workload and patient complexity. End-of-life marks a period of declining immune function, increasing frailty and declining cognitive function. Some 55% of a person’s lifetime stay in an acute hospital can occur in the last year of life, and more specifically in the last 22 weeks of life. Death is therefore a retrospective marker of escalating acute intervention for a seeming confusing jumble of conditions. Marginal changes in death appear to drive the marginal changes in physician workload in both volume of admissions, apparent case-mix, in-hospital deaths and occupied beds. In addition to the more widely recognised seasonal cycles, there are outbreaks, possibly caused by a yet unidentified infectious pathogen(s), which lead to 12-month periods of higher deaths, medical admissions and health care worker sickness absenteeism.
