Vignette 1.

Typical ward care received

A 79-year-old woman was admitted to hospital at 9pm following a fall and increasing shortness of breath. She was seen rapidly by a consultant within 2 hours of admission and COVID-19 was considered to be the diagnosis.
A rapid decision was reached that she should not be escalated to intensive treatment unit. This was well-documented and with the full agreement of the multidisciplinary team (MDT) and patient. All subsequent documentation was of a high standard. Contact with relatives was completed in a timely manner. While receiving ward care, the patient was referred to the appropriate specialties with gastroenterology, diabetes and renal teams all involved. There was good awareness of the patient's multiple conditions. Nursing care was of a high standard, as was associated documentation. Blood sugars were well-documented. Chest X-ray on admission showed mild bilateral patchy shadowing. The COVID-19 swab was positive and the patient was managed with good infection prevention and control on a COVID-19 ward. There was senior involvement and MDT input at all stages and timely review from all specialties. She experienced a short period of hypoactive delirium while on the ward, which her relatives found distressing but was very well managed by the team.
The patient developed a low mood with some anxiety elements in the subsequent days and was mildly deconditioned, which was minimised by high-quality physiotherapy input. She was discharged to the community for further recovery and rehabilitation prior to being transferred to her previous residence.