This article is more than 5 years old. Information may no longer be current.

Nearly 20% of patients were discharged from hospital with unstable vital signs

An analysis of electronic health record data published in the Journal of General Internal Medicine found 18.7% of patients were discharged from the hospital with at least one vital sign instability.

Patients with any instabilities at discharge were at greater risk of death or readmission, Oanh Kieu Nguyen, MD, MAS, from the Department of Internal Medicine at UT Southwestern Medical Center, and colleagues found.

“Over the past 30 years, hospital length of stay has fallen dramatically, raising concern that many patients may be discharged before being stabilized,” they wrote. “Premature discharge, as indicated by the presence of unresolved clinical instabilities at discharge, is associated with higher post-discharge mortality and readmission rates.”

They hypothesized that vital sign instabilities may provide “an easily actionable target to help providers and hospitals further reduce 30-day post-discharge adverse events.”

Nguyen and colleagues conducted a multicenter observational cohort study of 32,835 adults. The investigators assessed any abnormalities in oxygen saturation, respiratory rate, blood pressure, heart rate or temperature within 24 hours of discharge.

Results showed 16.9% of patients who were discharged with one instability died or were readmitted compared with 21.2% of patients with two instabilities, 26% of patients with three or more instabilities and 12.8% of patients with no instabilities (P < .001).

Having at least one vital sign instability was associated with higher risk-adjusted odds of either readmission or death (AOR = 1.36; 95% CI, 1.26–1.48). In addition, patients who had at least three vital sign instabilities had increased odds of 30-day readmission (AOR 1.36; 95%, 0.81–2.30) and increased odds of death (AOR 3.91; 95 % CI, 1.69–9.06) compared with patients who had no instabilities.

Nguyen and colleagues also reported having at least two vital sign instabilities at the time of discharge had a positive likelihood ratio of 1.8 and a positive predictive value of 22% for readmission or death within 30 days.

“Vital sign instabilities in the 24 hours prior to discharge are common, and are associated with increased risk-adjusted rates of 30-day adverse post-discharge events, particularly death,” researchers concluded. “Discharge guidelines should include vital sign criteria for judging stability on discharge in order to improve disposition planning and post-discharge patient safety.”

They continued: “At a minimum, patients with one instability should be discharged with caution. Close outpatient follow-up and appropriate patient education about warning signs and symptoms that merit urgent medical attention may also be warranted. Individuals with two or more instabilities should likely remain in the hospital for continued treatment and observation in the absence of extenuating circumstances.”

Nguyen and colleagues wrote that post-acute care facilities may not be able to provide adequate care to patients with vital sign instabilities. They stressed the importance of identifying evidence-based discharge guidelines and patient safety interventions. – by Chelsea Frajerman Pardes

Disclosure: The researchers report no relevant financial disclosures.