Severity measure helps ensure timely discharge

Judging when to discharge pneumonia patients

Hospitalized pneumonia patients who have abnormal vital signs, mental confusion, or problems with eating or drinking in the 24 hours prior to discharge face a greater chance of hospital readmission or death than do other pneumonia patients. These are the findings of a recent study funded by the Agency for Healthcare Research and Quality and conducted by a team of researchers led by Ethan Halm, MD, MPH, of the Mount Sinai School of Medicine in New York City1.

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 that clinicians can use 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 (temperature, heart rate, blood pressure, respiratory rate, and oxygen levels in the blood) that are checked several times a day in hospitalized patients, as well as an assessment of the patient’s mental status and ability to eat and drink.

Halm and his colleagues found that patients who were discharged "medically unstable" — defined as having problems with at least one of the seven factors in the measure — had a 30% higher chance of readmission or death and a 50% higher chance of not returning to their usual activities within 30 days. Medically unstable patients constituted 20% of pneumonia discharges in the study. In addition, the researchers found that the small proportion of patients who were discharged with two or more unstable factors had a fivefold greater risk of readmission or death.

The researchers contend 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. Halm also suggests that measuring stability before discharge can be used as an indicator of quality of care.


1. Halm E, Fine M, Kapoor W, et al. Instability on hospital discharge and the risk of adverse outcomes in patients with pneumonia. Arch Intern Med 2002; 162:1278-1284.