She is 71. Post-op day 2 after laparoscopic cholecystectomy. Vitals on every individual check look fine. 9 a.m. round: HR 84, BP 124/76, SpO₂ 97%, temp 37.2°C. 1 p.m.: HR 91, BP 118/72, SpO₂ 96%, temp 37.7°C. 3 p.m.: HR 96, BP 110/70, SpO₂ 94%, temp 38.1°C.

No individual number triggers a paper-based alarm. Each reading sits well within "normal." But the slope is unmistakable when you see all three together. Heart rate drifting up. Saturation drifting down. Temperature climbing.

This is what we mean by sepsis that walks in talking. Patients deteriorating slowly enough that no single check is alarming, fast enough to be a different patient by morning.

The Sepsis-3 redefinition (Singer et al., JAMA, 2016) made qSOFA a screening tool for exactly this kind of patient — three trivial measurements (RR ≥ 22, altered mental state, SBP ≤ 100) flagging a deteriorating trajectory. But qSOFA is still a point-in-time check. The published validation studies (Freund et al. and Raith et al., both JAMA, 2017) all use single measurements.

What's missing in the standard workflow is the trend strip. The view that shows you the patient's curve over the last six hours, on the same screen as their card, in a colour that shifts when the slope is wrong.

In Medows, the trend strip is the front layout for every bed card. HR, BP, SpO₂, and temp are inline mini-bars — six hours of history, colour-coded by direction. When the curve points the wrong way, the card shifts amber, then red, regardless of whether any individual value is critical.

For the patient above, the card was already amber at 1 p.m. and a soft red at 3 p.m. The PGT noticed it on the way to lunch, looked at the trend, asked Medows about the differential for a post-op day 2 patient with this trajectory. The response included blood cultures from two sites, lactate, urinalysis, a fluid challenge, and a flag to call surgery about possible bile leak.

Cultures grew E. coli. The bile leak was confirmed at re-look surgery the next morning. She went home on day 9. She was not an ICU admission. She walked out talking.

That is the case for a workspace. The trend was there in the data. It just needed a surface that showed it.