Bed 7. 62-year-old man, CCF with reduced ejection fraction, admitted for diuresis. Day 3. The morning round notes him as "comfortable, no acute issues."

10 a.m. obs: HR 78, BP 124/78, SpO₂ 96%, RR 18, weight 76.4 kg.
2 p.m. obs: HR 84, BP 118/72, SpO₂ 94%, RR 22, weight 77.1 kg.
6 p.m. obs: HR 92, BP 110/68, SpO₂ 92%, RR 24, weight 77.8 kg.
10 p.m. obs: HR 98, BP 102/64, SpO₂ 90% on room air, RR 28, weight 78.4 kg.

Three things are happening at once: he is gaining weight (fluid retention), his respiratory rate is climbing, and his oxygen is dropping. By 10 p.m. he is in decompensated CCF. He is on the same diuretic dose he was admitted on.

The night-shift resident arrives at 8 p.m. and is told, in handover, that Bed 7 is "stable, comfortable, day 3 CCF, no acute issues." He glances at the obs sheet, sees the 2 p.m. numbers, agrees with the handover, and moves on.

At 11:40 p.m. the patient is acutely short of breath. He needs BIPAP. He needs another 80 mg of frusemide. He needs an ABG. None of this is catastrophic — the patient recovers — but it is the kind of avoidable middle-of-the-night escalation that exhausts the night-shift team and prevents the patient from having a quiet night.

The catch should have happened at 6 p.m. The 6 p.m. obs were the inflection point — RR up from 18 to 24 in eight hours, SpO₂ dropping, weight up. A workspace that shows trends, with a card colour that shifts when the slope is wrong, catches this. A bedside obs sheet that records numbers in isolation does not.

This is why the bed card matters. Not because the doctor does not know to check trends. Because at the 6 p.m. round, with the senior pushing to leave for the night, the resident has eighty seconds at the patient's bedside, and the obs are on a chart on the wall that nobody is going to read forty numbers from.

If the card on the resident's phone had been amber at 6 p.m. — because the slope was wrong — the resident would have stopped. The patient would have gone on BIPAP at 7 p.m. The night-shift team would have had a quieter shift. The patient would have slept.