Photo courtesy of UT Southwestern Medical Center: From left to right, Oanh Nguyen, M.D., Anil Makam, M.D., Ethan A. Halm, M.D., of UT Southwestern's Center for Patient-Centered Outcomes Research.
Twenty percent of people hospitalized are sent home before their vital signs are stable, which can increase their risk of death and likelihood of readmission, a new study by UT Southwestern Medical Center researchers shows.
The study, published in the Journal of General Internal Medicine, analyzed the medical records of more than 32,000 patients at six providers in the Dallas-Fort Worth Area for red flags within 24 hours of discharge, such as anomalies in heart and breathing rate, oxygen saturation, blood pressure and temperature.
They found such signs in nearly 20 percent of subjects, with elevated heart rate the most common, comprising about 1 in 10 patients. About 13 percent of the patients studied either died or were readmitted, and for those experiencing at least three abnormalities, the risk of death quadrupled, according to the study.
"Our findings, that 'vital signs are still vital' have important implications for the development of national discharge guidelines to improve patient safety for the 35 million individuals being discharged from hospitals in the U.S. annually," co-lead author, Anil Makam, M.D., assistant professor of internal medicine and clinical sciences at the UT Southwestern Medical Center, said in an announcement about the study findings.
Going forward, there are a number of simple steps hospital leaders can take to safeguard against such oversights, according to the researchers. They suggest hospitals:
- Add vital sign criteria to discharge guidelines
- Discharge any patient who has one abnormal vial sign with extreme caution
- Keep patients who have two or more abnormal vital signs in the hospital
- Conduct thorough outpatient follow-up education
- Consider alternatives to post-acute care facilities, as a significant portion of patients discharged to such facilities are at increased risk for readmission or death
"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,” senior author Ethan A. Halm, M.D., chief of the division of outcomes and health services research at UT Southwestern’s Department of Clinical Sciences, said in the announcement.“There's a good reason we call them vital signs."