Instability on hospital discharge and the risk of adverse outcomes in patients with pneumonia

Ethan A. Halm, Michael J. Fine, Wishwa N. Kapoor, Daniel E. Singer, Thomas J. Marrie, Albert L. Siu

Research output: Contribution to journalArticle

158 Citations (Scopus)

Abstract

Background: Investigating claims that patients are being sent home from the hospital "quicker and sicker" requires a way of objectively measuring appropriateness of hospital discharge. Objective: To define and validate a simple, usable measure of clinical stability on discharge for patients with community-acquired pneumonia. Methods: Information on daily vital signs and clinical status was collected in a prospective, multicenter, observational cohort study. Unstable factors in the 24 hours prior to discharge were temperature greater than 37.8°C, heart rate greater than 100/min, respiratory rate greater than 24/min, systolic blood pressure lower than 90 mm Hg, oxygen saturation lower than 90%, inability to maintain oral intake, and abnormal mental status. Outcomes were deaths, readmissions, and failure to return to usual activities within 30 days of discharge. Results: Of the 680 patients, 19.1% left the hospital with 1 or more instabilities. Overall, 10.5% of patients with no instabilities on discharge died or were readmitted compared with 13.7% of those with 1 instability and 46.2% of those with 2 or more instabilities (P <.003). Instability on discharge (≥1 unstable factor) was associated with higher risk-adjusted rates of death or readmission (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.0-2.8) and failure to return to usual activities (OR, 1.5; 95% CI, 1.0-2.4). Patients with 2 or more instabilities had a 5-fold greater risk-adjusted odds of death or readmission (OR, 5.4; 95% CI, 1.6-18.4). Conclusions: Instability on discharge is associated with adverse clinical outcomes. Pneumonia guidelines and pathways should include objective criteria for judging stability on discharge to ensure that efforts to shorten length of stay do not jeopardize patient safety.

Original languageEnglish (US)
Pages (from-to)1278-1284
Number of pages7
JournalArchives of Internal Medicine
Volume162
Issue number11
StatePublished - Jun 10 2002

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Pneumonia
Odds Ratio
Confidence Intervals
Blood Pressure
Vital Signs
Patient Discharge
Patient Safety
Respiratory Rate
Observational Studies
Length of Stay
Cohort Studies
Heart Rate
Guidelines
Oxygen
Temperature
Mortality

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Halm, E. A., Fine, M. J., Kapoor, W. N., Singer, D. E., Marrie, T. J., & Siu, A. L. (2002). Instability on hospital discharge and the risk of adverse outcomes in patients with pneumonia. Archives of Internal Medicine, 162(11), 1278-1284.

Instability on hospital discharge and the risk of adverse outcomes in patients with pneumonia. / Halm, Ethan A.; Fine, Michael J.; Kapoor, Wishwa N.; Singer, Daniel E.; Marrie, Thomas J.; Siu, Albert L.

In: Archives of Internal Medicine, Vol. 162, No. 11, 10.06.2002, p. 1278-1284.

Research output: Contribution to journalArticle

Halm, EA, Fine, MJ, Kapoor, WN, Singer, DE, Marrie, TJ & Siu, AL 2002, 'Instability on hospital discharge and the risk of adverse outcomes in patients with pneumonia', Archives of Internal Medicine, vol. 162, no. 11, pp. 1278-1284.
Halm EA, Fine MJ, Kapoor WN, Singer DE, Marrie TJ, Siu AL. Instability on hospital discharge and the risk of adverse outcomes in patients with pneumonia. Archives of Internal Medicine. 2002 Jun 10;162(11):1278-1284.
Halm, Ethan A. ; Fine, Michael J. ; Kapoor, Wishwa N. ; Singer, Daniel E. ; Marrie, Thomas J. ; Siu, Albert L. / Instability on hospital discharge and the risk of adverse outcomes in patients with pneumonia. In: Archives of Internal Medicine. 2002 ; Vol. 162, No. 11. pp. 1278-1284.
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AU - Marrie, Thomas J.

AU - Siu, Albert L.

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