Routine complement blood tests are insensitive for alternative complement activation

sion of care. Therefore, it is possible that the recognition of dying and discussions with patients and their families may have occurred earlier or more frequently than actually documented. However, this does highlight the importance of adequate documentation regarding clinical assessments, recognition of deterioration and communication about end-of-life care in medical records. We also concur with the opinion of Russell that the appropriateness of medical interventions in the last 48 h of life is dependent on individual clinical scenarios. However, it is challenging to distinguish between these possibilities, particularly when there is uncertainty about a patient’s prognosis. As suggested, a comparison with patients who did not die may shed some light on this but was beyond the scope of our current study. It could also be argued that the rapid response reviews and alterations to resuscitation plans could have been appropriate or inappropriate depending on the patient’s clinical status. However, our paper sought to highlight the significant number of rapid response reviews and that this may not be the optimal time for the discussion of goals of care given the limited knowledge and rapport that the rapid response teams usually have with patients and their caregivers. We do acknowledge, however, that this may not always be avoidable. To improve the study further, we have iteratively reviewed and developed a revised audit tool that better reflects and audits the clinical patterns of care in our hospital service. This approach could become an integrated quality improvement activity to assist in understanding, and therefore improving, end-of-life care. In conclusion, the recognition and management of dying is complex. However, we believe that the delivery of end-of-life care in hospitals can be improved, and we look forward to presenting the results of our revised audit in the near future.