Key result
Discharge heart rate >100 and respiratory rate >20 linked to ~87% higher 7-day readmission risk.
Why the study?
Assessing vital sign stability in the 24 hours before discharge has been suggested to determine discharge safety, prompting evaluation of its association with readmission rates.
Are unstable vital signs at hospital discharge associated with increased readmission rates in medical floor patients?
Cohort (n=29,322)
Yes
Are unstable vital signs at hospital discharge associated with increased readmission rates in medical floor patients?
Unstable vital signs at discharge, particularly a combination of tachycardia and tachypnea, are significantly associated with an increased risk of seven-day hospital readmission.
Answers are grounded in this paper and cite their sources.
May flag high-risk discharges for monitoring; hypothesis-generating for trials targeting pre-discharge vital sign optimization.
BACKGROUND: Assessing the stability of a patient's vital signs in the 24 hours before discharge has been suggested as an objective and inexpensive way to determine safety for discharge. AIM: To determine the association between unstable vital signs at the time of discharge with the readmission rate over a one-year period. DESIGN: An observational cohort multi-center study at three urban community hospitals using electronic health record data collected from November 1, 2016, to October 30, 2017. METHODS: A total of 29322 hospitalizations to medical floors with complete sets of vital signs were included. The final vital signs collected on the day of discharge were used for analysis. The readmission rates were compared using different variables such as age, sex, insurance payer (Medicare or Medicaid), discharge time, discharge disposition, length of stay at the hospital, the number, and type of abnormal vital signs at discharge. RESULTS: Unstable vital signs at discharge were found in 2862 patients (9.8%). The readmission rate was highest in patients with two (11.3%) unstable vital signs compared to those with one (8.5%) and three or more (0%) instabilities. Patients with a combination of heart rate >100 beats/min and respiratory rate >20 breaths/min at discharge had a 14.1% seven-day readmission rate (P = 0.0057, Odds Ratio = 1.87, Confidence Interval = 1.19-2.95). CONCLUSIONS: Vital sign instabilities in the 24 hours before discharge are associated with increased seven-day readmission rate.
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Pittappilly et al. (2019) conducted a cohort in Hospitalizations to medical floors (n=29,322). Unstable vital signs at discharge vs. Stable vital signs was evaluated on Seven-day readmission rate (OR 1.87, 95% CI 1.19-2.95, p=0.0057). A combination of heart rate >100 and respiratory rate >20 at discharge was associated with an increased 7-day readmission rate (OR 1.87; 95% CI 1.19-2.95; P=0.0057).
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