Vital sign instability at hospital discharge linked to increased mortality risk
Nearly 17% of patients exhibiting one unstable vital sign at hospital discharge were readmitted or died within 30 days.
Instability of vital signs, including abnormalities in temperature, heart rate, blood pressure, respiratory rate, and oxygen saturation, have been associated with an increased likelihood of 30-day hospital readmission or mortality, according to research published in the Journal of General Internal Medicine.
Oanh Kieu Nguyen, MD, MAS, Division of General Internal Medicine, Department of Internal Medicine, UT Southwestern Medical Center, and colleagues conducted a multi-center, observational cohort study using data collected from patients' electronic health records. The researchers noted any abnormalities in temperature, heart rate, blood pressure, respiratory rate, and oxygen saturation that occurred within 24 hours of discharge.
The study included 32,835 patients; 18.7% were discharged with 1 or more vital sign instability. Across all patients, 12.8% with no instability on discharge were either readmitted or died, while 16.9%, 21.2%, and 26% with 1, 2, or 3 or more instabilities, respectively, were either readmitted or died.
“The presence of any instability was associated with higher risk-adjusted odds of either death or readmission, and was more strongly associated with death,” noted Dr Nguyen. “Individuals with 3 or more instabilities had nearly fourfold increased odds of death and increased odds of 30-day readmission.”
“Simple vital sign criteria could be used to assess safety for discharge, and to reduce 30-day mortality and readmission,” he concluded.
- Nguyen OK, Makam AN, Clark C. Vital signs are still vital: Instability on discharge and the risk of post-discharge adverse outcomes. J Gen Intern Med. 2016; doi: 10.1007/s11606-016-3826-8