Shortened hospital stays may be causing patients to be released from the hospital too early, resulting in increased rates of rehospitalization and death, according to a new study.
Nearly one in five patients is released from the hospital when their vital signs are unstable, which researchers at the University of Texas Southwestern Medical Center say is an irresponsible practice resulting in the need for additional treatment, or death, that could be avoided.
“At a time when people are developing complicated, black box computerized algorithms to identify patients at high risk of readmission, 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,” Dr. Ethan Halm, director of UT Southwestern’s Center for Patient-Centered Outcomes Research, said in a press release. “There’s a good reason we call them vital signs.”
Vital signs include temperature, heart rate, blood pressure, respiratory rate and oxygen saturation. The measures are typically monitored continuously while patients are treated in the hospital and, ideally, are considered when deciding whether to allow a patient to go home.
The new study, published in the Journal of General Internal Medicine, suggests doctors and nurses are not paying enough attention to the basic measures of bodily function.
After analyzing medical records for 32,835 patients at six hospitals in the Dallas-Fort Worth area, researchers found 18.7 percent of patients were discharged with one or more vital sign instabilities.
Among all patient records in the study, 12.8 percent of patients discharged with no instabilities died or were readmitted within 30 days, while 16.9 percent of patients with one unstable sign, 21.2 percent of those with two instabilities and 26 percent of those with three or more instabiities died or were readmitted to the hospital.
The researchers suggest better objective measures of vital sign stability be instituted at hospitals. They suggest patients with one unstable vital sign be discharged with caution, while patients with two or more unstable vital signs likely should not be discharged.
“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,” said Dr. Oanh Nguyen, an assistant professor of internal medicine and clinical sciences at UT Southwestern.