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New measure may help prevent patients with pneumonia from being sent home from the hospital too soon

Hospitalized pneumonia patients who have abnormal vital signs, mental confusion, or problems with eating or drinking in the 24 hours prior to discharge are more likely not to be able to resume normal activities, and they face a greater chance of hospital readmission or death compared with other pneumonia patients. These are the findings of a recent study funded by the Agency for Healthcare Research and Quality (HS09973) and conducted by a team of researchers led by Ethan A. Halm, M.D., M.P.H., of the Mount Sinai School of Medicine.

Dr. Halm and his colleagues focused on the potential danger of releasing pneumonia patients from the hospital "quicker and sicker." They developed a simple severity-of-illness measure for patients with pneumonia. Clinicians can use the measure to judge whether it is safe for the patients to be discharged from the hospital. The measure uses information from the five basic vital signs that are checked several times a day in hospitalized patients (temperature, heart rate, blood pressure, respiratory rate, and oxygen levels in the blood), as well as an assessment of the patient's mental status and ability to eat and drink.

Dr. Halm and his colleagues found that patients who were medically unstable—that is, having problems with at least one of the seven factors in the measure—had a 30 percent increased chance of readmission or death and a 50 percent higher chance of not returning to their usual activities within 30 days. The researchers found that the small proportion of patients who were discharged with two or more unstable factors had a five-fold greater risk of readmission or death. Using their instrument, Dr. Halm and his colleagues found that one in five of the patients they studied had been discharged "medically unstable."

The researchers believe that hospital and insurance plan guidelines that shorten the length of hospital stays should build in a safety check to measure clinical stability prior to discharge to make sure that patients are not sent home too soon. Dr. Halm also suggests that measuring stability before discharge can be used as an indicator of quality of care. Further, measures of patient stability could also be used to compare provider and health plan performance and to stimulate quality improvement activities.

For more information see "Instability on hospital discharge and the risk of adverse outcomes in patients with pneumonia," by Dr. Halm, Michael J. Fine, M.D., M.Sc., Wishwa N. Kapoor, M.D., M.P.H., and others, in the June 10, 2002 Archives of Internal Medicine 162, pp. 1278-1284.

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