Playing D&D 5e on Hard Mode: High-Stakes Gameplay
There are several ideas in D&D 5e books to help steer in this gritty direction; I’ll summarize the ones that I know of. I’ll also provide homebrew ideas for how to play D&D 5e on epic difficulty.
lingering injuries
Lingering Injuries: How to Make D&D 5e Wounds Matter
Instead of settling for the boring options of dead or not dead, use grievous injuries to up the stakes. You can create value for high-level healing and resurrection spells while keeping players worried about losing their heads when lingering injuries are possible!