About one in five patients discharged from the hospital has unstable vital signs, which is associated with an increased risk of death or readmission, according to a study published Monday in the Journal of General Internal Medicine.
Researchers from University of Texas Southwestern Medical Center and Parkland Health & Hospital System analyzed EHR data on about 33,000 patients from six hospitals in the Dallas-Fort Worth area for abnormalities in blood pressure, respiratory rate, heart rate, temperature, and oxygen saturation within 24 hours of discharge.
The researchers found that, of patients who had no vital sign abnormalities at discharge, about 13 percent died or were readmitted within 30 days of discharge. By comparison:
- 16.9 percent of patients with one abnormality at discharge died or were readmitted within 30 days of discharge;
- 21.2 percent of patients with two abnormalities at discharge died or were readmitted within 30 days of discharge; and
- 26 percent of patients with three or more abnormalities at discharge died or were readmitted within 30 days of discharge.
Elevated heart rate was the most common abnormality at discharge, presenting in about 10 percent of patients.
In all, 18.7 percent of discharged patients had at least one vital sign abnormality at discharge.
Study co-author Ethan Halm said, "There's a good reason we call them vital signs." He said, "Our study highlights that the stability of vital signs, something doctors review with their own eyes every day, is a simple, clinically objective means of assessing readiness and safety for discharge," adding that "it is important for clinicians to look at all of the vital signs in the 24 hours prior to discharge and not just the last set or the best ones in judging a patient's readiness for discharge."
Study co-author Anil Makam said the findings "have important implications for the development of national discharge guidelines to improve patient safety for the 35 million individuals being discharged from hospitals in the [United States] annually."
The study authors suggested that hospital leaders take steps to safeguard against discharging patients prematurely, including:
- Adding vital sign criteria to discharge guidelines;
- Using caution when discharging a patient with one vital abnormality; and
- Not discharging most patients with two or more vital sign abnormalities (Budryk, FierceHealthCare, 8/10; Feller, United Press International, 8/9; Zimmerman, Becker's Infection Control & Clinical Quality, 8/10; Mongan, McKnight's Long Term Care News, 8/10; UT Southwestern Medical Center release, 8/9).
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