Characteristics of patients with cardiorespiratory instability in a step-down unit.

BACKGROUND Patients in step-down units are at higher risk for developing cardiorespiratory instability than are patients in general care areas. A triage tool is needed to identify at-risk patients who therefore require increased surveillance. OBJECTIVES To determine demographic (age, race, sex) and clinical (Charlson Comorbidity Index at admission, admitting diagnosis, care area of origin, admission service) differences between patients in step-down units who did and did not experience cardiorespiratory instability. METHODS In a prospective longitudinal pilot study, 326 surgical-trauma patients had continuous monitoring of heart rate, respirations, and oxygen saturation and intermittent noninvasive measurement of blood pressure. Cardiorespiratory instability was defined as heart rate less than 40/min or greater than 140/min, respirations less than 8/min or greater than 36/min, oxygen saturation less than 85%, or blood pressure less than 80 or greater than 200 mm Hg systolic or greater than 110 mm Hg diastolic. Patients' status was classified as unstable if their values crossed these thresholds even once during their stay. RESULTS Cardiorespiratory instability occurred in 34% of patients. The Charlson Comorbidity Index was the only variable associated with instability conditions. Compared with patients with no comorbid conditions (50%), more patients with at least 1 comorbid condition (66%) experienced instability (P = .006). Each 1-unit increase in the Charlson Index increased the odds for cardiorespiratory instability by 1.17 (P = .03). CONCLUSION Although the relationship between Charlson Comorbidity Index and cardiorespiratory instability was weak, adding it to current surveillance systems might improve detection of instability.

[1]  R. Deyo,et al.  Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. , 1992, Journal of clinical epidemiology.

[2]  J. Depriest.  Low Incidence of Hemodynamic Instability in Patients With Gastrointestinal Hemorrhage , 1996, Southern medical journal.

[3]  L. Aiken,et al.  Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. , 2002, JAMA.

[4]  G. Moore,et al.  Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study , 2002, BMJ : British Medical Journal.

[5]  D. Sapoznikov,et al.  Predictors of haemodynamic instability and heart rate variability during haemodialysis. , 2004, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[6]  D. Goldhill,et al.  Physiological abnormalities in early warning scores are related to mortality in adult inpatients. , 2004, British journal of anaesthesia.

[7]  M. Devita,et al.  Use of medical emergency team responses to reduce hospital cardiopulmonary arrests , 2004, Quality and Safety in Health Care.

[8]  A. McGinley,et al.  A physiologically‐based early warning score for ward patients: the association between score and outcome * , 2005, Anaesthesia.

[9]  V. Novack,et al.  Adverse outcomes in patients with community acquired pneumonia discharged with clinical instability from Internal Medicine Department , 2006, Scandinavian journal of infectious diseases.

[10]  K. Hillman,et al.  Findings of the First Consensus Conference on Medical Emergency Teams* , 2006, Critical care medicine.

[11]  Larry J. Eshelman,et al.  Development and Evaluation of Predictive Alerts for Hemodynamic Instability in ICU Patients , 2008, AMIA.

[12]  M. Hravnak,et al.  Defining the incidence of cardiorespiratory instability in patients in step-down units using an electronic integrated monitoring system. , 2008, Archives of internal medicine.

[13]  Paul E. Schmidt,et al.  Review and performance evaluation of aggregate weighted 'track and trigger' systems. , 2008, Resuscitation.

[14]  D. Prytherch,et al.  Should age be included as a component of track and trigger systems used to identify sick adult patients? , 2008, Resuscitation.

[15]  V. Palmieri,et al.  Increased troponin I predicts in-hospital occurrence of hemodynamic instability in patients with sub-massive or non-massive pulmonary embolism independent to clinical, echocardiographic and laboratory information. , 2008, International journal of cardiology.

[16]  Gary B. Smith,et al.  ViEWS--Towards a national early warning score for detecting adult inpatient deterioration. , 2010, Resuscitation.

[17]  Inga Adams-Pizarro,et al.  "Identifying the hospitalised patient in crisis"--a consensus conference on the afferent limb of rapid response systems. , 2010, Resuscitation.

[18]  Marilyn Hravnak,et al.  Cardiorespiratory instability before and after implementing an integrated monitoring system* , 2011, Critical care medicine.

[19]  Arthas Flabouris,et al.  Documenting Rapid Response System afferent limb failure and associated patient outcomes. , 2011, Resuscitation.