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One in five patients discharged with unstable vital signs, finds US study

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Around 20% of US hospital patients are discharged before all their vital signs are stable, a pattern associated with an increased risk of death and readmission, according to researchers.

As hospital stays have shortened dramatically over the past 30 years, there is increasing concern that patients are being discharged before all vital signs have stabilised, they warned.

“It is important for clinicians to look at all of the vital signs in the 24 hours prior to discharge”

Ethan Halm

Theirs is the first study to examine the extent to which hospital patients in the US are discharged with unstable vital signs, and whether doing so is linked to higher mortality and readmission rates.

The researchers assessed the records of 32,835 patients, noting abnormalities in temperature, heart rate, blood pressure, respiratory rate, and oxygen saturation within 24 hours of discharge.

Nearly 20% of patients had one or more abnormalities, with elevated heart rate being the most common, according to the researchers from the University of Texas Southwestern Medical Center.

About 13% were readmitted or died, and those with three or more instabilities had a nearly four-fold increase in mortality risk, said the study authors in the Journal of General Internal Medicine.

They recommended that guidelines should include objective vital sign criteria for judging stability and that, as a minimum, patients with one instability should be discharged “with caution”.

The researchers also called for close outpatient follow-up and patient education about warning signs and symptoms, noting that those with two or more instabilities should probably stay in the hospital.

Study lead author Dr Oanh Nguyen said: “We found that nearly one in five hospitalised adults is discharged with one or more vital sign instabilities such as an elevated heart rate or low blood pressure.

“This finding is an important patient safety issue because patients who had vital sign abnormalities on the day of discharge had higher rates of hospital readmission and death within 30 days even after adjusting for many other risk factors,” she added.

University of Texas Southwestern Medical Center

Checking vital sign stability ‘key before discharge’

Ethan Halm

Senior author Dr Ethan Halm noted that, at a time when complicated computer algorithms were being developed to identify patients at high risk of readmission, the study highlighted that vital sign stability was a “simple, clinically objective means of assessing readiness and safety for discharge”.

“There’s a good reason we call them vital signs,” he said. “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.”

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