Study Finds One in Five Hospital Patients Discharged With Unstable Vital Signs, Adding to Readmissions

Elevated heart rate is most-common vital-sign instability

Twenty percent of people hospitalized are released before all vital signs are stable, a pattern that is associated with an increased risk of death and hospital readmission, a new study from the University of Texas Southwestern Medical Center shows. The findings were published in the Journal of General Internal Medicine.

As hospital stays have shortened dramatically during the past 30 years, there is increasing concern that patients are being discharged before all vital signs have stabilized, putting them at risk of adverse events after discharge. However, no studies have examined the extent to which patients are discharged with unstable vital signs, and whether this practice is associated with higher post-discharge mortality and readmission rates, the researchers said.

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

The researchers assessed the electronic medical records of 32,835 patients at six Dallas–Fort Worth area hospitals, and noted abnormalities in temperature, heart rate, blood pressure, respiratory rate, and oxygen saturation within 24 hours of discharge. Nearly 20% had one or more abnormalities, with elevated heart rate being the most common vital-sign instability (affecting approximately 10% of the patients). Approximately 13% were readmitted or died, and individuals with three or more instabilities had a nearly fourfold increase in the odds of death.

The researchers concluded that:

  • Discharge guidelines should include objective vital-sign criteria for judging stability on discharge to improve disposition planning and post-discharge patient safety.
  • 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 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.
  • Although post-acute care facilities are common sites of post-discharge care for those discharged with vital-sign instabilities, patients sent to those facilities had still higher rates of readmission and death, suggesting that an alternate site of discharge may have been more appropriate for a significant subset of these individuals.

Sources: UT Southwestern Medical Center; August 10, 2016; and JGIM; August 8, 2016.