Vital Sign Abnormalities on Discharge Do Not Predict 30-Day Readmission

Area of Science:

• Internal Medicine
• Healthcare Quality Improvement
• Patient Safety

Background:

• Hospital readmissions represent a significant financial burden and a marker of suboptimal care.
• Identifying reliable predictors of readmission is crucial for targeted interventions.
• Vital sign abnormalities (VSA) at discharge have been proposed as a potential risk factor for readmission.

Purpose of the Study:

• To evaluate the utility of vital sign abnormalities (VSA) at discharge as a predictor of 30-day hospital readmission.
• To compare the predictive performance of VSA against established risk assessment tools: the HOSPITAL score and the LACE index.

Main Methods:

• Retrospective analysis of adult internal medicine patients discharged from a university-affiliated tertiary care center.
• Data extraction from electronic health records, including demographics, diagnoses, vital signs at discharge, and 30-day readmission status.
• Comparison of VSA, HOSPITAL score, and LACE index using receiver operating characteristic (ROC) analysis.

Main Results:

• Vital sign abnormalities (VSA) were present in 13% of the study cohort.
• No significant association was found between VSA at discharge and 30-day hospital readmission (C statistic = 0.52, P = 0.318).
• The HOSPITAL score (C statistic = 0.67) and LACE index (C statistic = 0.61) demonstrated significant predictive value for readmission.

Conclusions:

• Vital sign abnormalities (VSA) at the time of hospital discharge are not a useful predictor of 30-day readmission.
• The validated HOSPITAL score and LACE index are superior tools for predicting readmission risk in this patient population.
• Focusing on established risk stratification tools is recommended for effective readmission reduction strategies.