Abstract

Readmissions are treated as adverse events in many healthcare systems. Causes can be physiological deterioration or breakdown of social support systems.

We investigated data from a European multi-centre study of readmissions for changes in vital signs between index admission and readmission. Data sets were graded according to the National Early Warning Score (NEWS).

Of 487 patients in whom NEWS could be calculated on discharge and again on re-admission, 39.6% had worse vital signs with a NEWS score difference ≥ 2 points while only 7.6% had improved by ≥ 2 points. Changes in individual vital signs of 20% or more were most common in respiratory rate and heart rate.

Monitoring of respiratory rate and pulse rate post-discharge might predict some deteriorations.

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References

1. Greysen SR, Stijacic Cenzer I, et al. Functional impairment and hospital readmission in Medicare seniors. JAMA Intern Med. 2015;175:559-565.
2. Fluitman KS, van Galen LS, Merten H, et al. Exploring the preventable causes of unplanned readmissions using root cause analysis: Coordination of care is the weakest link. Eur J Intern Med. 2016;30:18-24.
3. van Galen LS, Brabrand M, Cooksley T, et al. Patients’ and providers’ perceptions of the preventability of hospital readmission: a prospective, observational study in four European countries. BMJ Qual Saf. 2017;26:958-969.
4. van Galen LS, Cooksley T, Merten H, et al. Physician consensus on preventability and predictability of readmissions based on standard case scenarios. Neth J Med. 2016;74:434-442.
5. Nguyen OK, Makam AN, Clark C, et al. Vital Signs Are Still Vital: Instability on Discharge and the Risk of Post-Discharge Adverse Outcomes. J Gen Intern Med. 2017;32:42-48.
6. Jones M. NEWSDIG: The National Early Warning Score Development and Implementation Group. Clin Med (Lond). 2012;12:501-503.
7. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489-495.
8. Charlson M, Szatrowski TP, Peterson J, et al. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47:1245-1251.
9. Rubio N, Parker RA, Drost EM, et al. Home monitoring of breathing rate in people with chronic obstructive pulmonary disease: observational study of feasibility, acceptability, and change after exacerbation. Int J Chron Obstruct Pulmon Dis. 2017;12:1221-1231.
10. Sanchez-Morillo D, Fernandez-Granero MA, Leon-Jimenez A. Use of predictive algorithms in-home monitoring of chronic obstructive pulmonary disease and asthma: A systematic review. Chron Respir Dis. 2016;13:264-283.
11. Kohn MS, Haggard J, Kreindler J, et al. Implementation of a Home Monitoring System for Heart Failure Patients: A Feasibility Study. JMIR Res Protoc. 2017;6:e46.
12. Triantafyllidis A, Velardo C, Chantler T, et al. A personalised mobile-based home monitoring system for heart failure: The SUPPORT-HF Study. Int J Med Inform. 2015;84:743-753.
13. Silcock DJ, Corfield AR, Gowens PA, et al. Validation of the National Early Warning Score in the prehospital setting. Resuscitation. 2015;89:31-35.
14. Williams TA, Tohira H, Finn J et al. The ability of early warning scores (EWS) to detect critical illness in the prehospital setting: A systematic review. Resuscitation. 2016;102:35-43.
15. Nabayigga B, Kellett J, Brabrand M, et al. The mortality of acutely ill medical patients for up to 60days after admission to a resource poor hospital in sub-Saharan Africa compared with patients of similar illness severity admitted to a Danish Regional Teaching Hospital-an exploratory observational study. Eur J Intern Med.
    2016;27:24-30.
16. Subbe CP, Duller B. Continuous monitoring of respiratory rate on general wards. Acute Med. 2018;17(1): 5-9.
17. Ovaisi S, Ibison J, Leontowitsch M, et al. Stroke patients’ perceptions of home blood pressure monitoring: a qualitative study. Br J Gen Pract. 2011;61:e604-610.
18. Pinna GD, Maestri R, Andrews D, et al. Home telemonitoring of vital signs and cardiorespiratory signals in heart failure patients: system architecture and feasibility of the HHH model. Int J Cardiol. 2007;120:371-379.