Vital signs on hospital discharge and re admission rates.
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.