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New Measure May Help Prevent Patients With Pneumonia From Being Sent Home Too Soon

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Research Alert: June 9, 2002

Hospitalized pneumonia patients who have abnormal vital signs, mental confusion, problems with eating or drinking in the 24 hours prior to discharge are more likely not to be able to resume normal activities, and face a greater chance of hospital readmission or death, according to a study funded by the Agency for Healthcare Research and Quality. The study will be published in the June 10 issue of Archives of Internal Medicine.

The research team, led by Ethan A. Halm, M.D., M.P.H., of the Mount Sinai School of Medicine, focused on the potential danger of releasing pneumonia patients from the hospital "quicker and sicker." They developed a simple measure of how sick patients with pneumonia are that can be used to judge whether it is safe for them 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—defined as 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 risk of readmission or death was 5 times greater for the small proportion of patients who were discharged with two or more unstable factors. Using their instrument, Halm and his colleagues found that 1 in 5 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 proposes that measuring stability before discharge can be used as an indicator of quality of care. This also can be used to compare provider and health plan performance or to stimulate quality improvement activities.

Editor's Note: Interviews with Dr. Halm may be arranged by contacting Debra Kaplan at Mount Sinai School of Medicine Public Affairs, (212) 659-9045.

For more information, please contact AHRQ Public Affairs, (301) 427-1364: Karen Carp, (301) 427-1858 (; Farah Englert, (301) 427-1865 (


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