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Deviating vital signs in continuous monitoring prior to discharge and risk of readmission: an observational study

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Abstract

Premature discharge may result in readmission while longer hospitalization may increase risk of complications such as immobilization and reduce hospital capacity. Continuous monitoring detects more deviating vital signs than intermittent measurements and may help identify patients at risk of deterioration after discharge. We aimed to investigate the association between deviating vital signs detected by continuous monitoring prior to discharge and risk of readmission within 30 days. Patients undergoing elective major abdominal surgery or admitted with acute exacerbation of chronic obstructive pulmonary disease were included in this study. Eligible patients had vital signs monitored continuously within the last 24 h prior to discharge. The association between sustained deviated vital signs and readmission risk was analyzed by using Mann–Whitney’s U test and Chi-square test. A total of 51 out of 265 patients (19%) were readmitted within 30 days. Deviated respiratory vital signs occurred frequently in both groups: desaturation < 88% for at least ten minutes was seen in 66% of patients who were readmitted and in 62% of those who were not (p = 0.62) while desaturation < 85% for at least five minutes was seen in 58% of readmitted and 52% of non-readmitted patients (p = 0.5). At least one sustained deviated vital sign was detected in 90% and 85% of readmitted patients and non-readmitted patients, respectively (p = 0.2). Deviating vital signs prior to hospital discharge were frequent but not associated with increased risk of readmission within 30 days. Further exploration of deviating vital signs using continuous monitoring is needed.

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Funding

This work was supported by the Innovation Fund Denmark [8056-00055B], Capital Region of Denmark’s Research Foundation, Bispebjerg Hospital, Rigshospitalet, and Technical University of Denmark. No sponsor had any role in the study design, collection of data, analysis, access to the data, interpretation of data, writing, or the decision to submit the article.

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Authors and Affiliations

  1. Department of Anaesthesia and Intensive Care, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Bispebjerg, Bakke 23, 2400, Copenhagen, NV, Denmark

    Nicharatch Songthawornpong, Mikkel Elvekjaer & Christian S. Meyhoff

  2. Department of Anaesthesiology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark

    Jesper Mølgaard, Eske K. Aasvang & Vibeke R. Eriksen

  3. Biomedical Engineering, Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark

    Søren M. Rasmussen

  4. Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark

    Nicharatch Songthawornpong, Mikkel Elvekjaer & Christian S. Meyhoff

  5. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Christian S. Meyhoff & Eske K. Aasvang

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  1. Nicharatch Songthawornpong
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  2. Mikkel Elvekjaer
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  4. Søren M. Rasmussen
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  5. Christian S. Meyhoff
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  6. Eske K. Aasvang
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  7. Vibeke R. Eriksen
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Correspondence to Nicharatch Songthawornpong.

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Conflict of interest

Christian S. Meyhoff and Eske K. Aasvang have founded a start-up company, WARD247 ApS, to pursue the WARD-projects regulatory and commercial activities. WARD247 ApS has finalized terms for license agreement for any WARD-project software and patents, of which one has been filed. WARD247 ApS has not had any influence on the study design, conduct, analysis or reporting. Christian S. Meyhoff and Eske K. Aasvang reports lecture fees from Radiometer. Nicharatch Songthawornpong, Mikkel Elvekjaer, Jesper Mølgaard, Søren M Rasmussen and Vibeke R. Eriksen declare no conflict of interest.

Human and animal rights

This analysis was based upon data from two previous observational studies (NCT03491137 and NCT03660501), both approved by the Danish Data Protection Agency.

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Songthawornpong, N., Elvekjaer, M., Mølgaard, J. et al. Deviating vital signs in continuous monitoring prior to discharge and risk of readmission: an observational study. Intern Emerg Med 18, 1453–1461 (2023). https://doi.org/10.1007/s11739-023-03318-4

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