Vignette 4.

Documenting decisions, delays and escalation

A 46-year-old woman with a known learning disability was admitted acutely from her sheltered and warden-controlled accommodation where she was fully independent. Her body mass index was 34 kg/m2. She was seen in the emergency department (ED) with shortness of breath and it was assumed that she had COVID-19. She was not reviewed by the admitting team for 12 hours, but an X-ray carried out by the ED team showed typical features of COVID-19 pneumonia.
There was evidence of a discussion about do not attempt cardiopulmonary resuscitation on the post-take ward round, but it was not clear and not documented on what basis the decision to restrict to ward-level care was made.