title: Risk for Cardiorespiratory Instability Following Transfer to a Monitored Step-Down Unit.
abstract: BACKGROUND
  Hospitalized patients who develop at least one instance of cardiorespiratory instability (CRI) have poorer outcomes. We sought to describe the admission characteristics, drivers, and time to onset of initial CRI events in monitored step-down unit (SDU) patients.
  
  
  METHODS
  Admission characteristics and continuous monitoring data (frequency 1/20 Hz) were recorded in 307 subjects. Vital sign deviations beyond local instability trigger threshold criteria, with a tolerance of 40 s and cumulative duration of 4 of 5 min, were classified as CRI events. The CRI driver was defined as the first vital sign to cross a threshold and meet persistence criteria. Time to onset of initial CRI was the number of days from SDU admission to initial CRI, and duration was length of the initial CRI epoch.
  
  
  RESULTS
  Subjects transferred to the SDU from units with higher monitoring capability were more likely to develop CRI (CRIn= 133 [44%] vs no CRIn= 174 [31%]P= .042). Time to onset varied according to the CRI driver. Subjects with at least one CRI event had a longer hospital stay (CRI 11.3 ± 10.2 d vs no CRI 7.8 ± 9.2 d,P< .001) and SDU stay (CRI 6.1 ± 4.9 d vs no CRI 3.5 ± 2.9 d,P< .001). First events were more often due to SpO2, whereas breathing frequency was the most common driver of all CRI.
  
  
  CONCLUSIONS
  Initial CRI most commonly occurred due to SpO2and was associated with prolonged SDU and hospital stay. Findings suggest the need for clinicians to more closely monitor SDU patients transferred from an ICU and parameters (SpO2, breathing frequency) that more commonly precede CRI events.
authors.affiliation: School of Nursing, University of Texas, Austin, Texas. ebose@nursing.utexas.edu.
authors.forename: Eliezer
authors.initials: E
authors.lastname: Bose
authors.affiliation: Auton Laboratory, Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania.
authors.forename: Lujie
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Critical Care Medicine.
authors.forename: Gilles
authors.initials: G
authors.lastname: Clermont
authors.affiliation: Auton Laboratory, Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania.
authors.forename: Artur
authors.initials: A
authors.lastname: Dubrawski
authors.affiliation: Department of Critical Care Medicine.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Pinsky
authors.affiliation: Department of Health and Community Systems, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Dianxu
authors.initials: D
authors.lastname: Ren
authors.affiliation: Department of Acute/Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Hoffman
authors.affiliation: Department of Acute/Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Hravnak
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006757:Hospital Units / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011660:Pulmonary Heart Disease / Q000209:etiology*; D012131:Respiratory Insufficiency / Q000209:etiology*; D012307:Risk Factors
keywords: cardiorespiratory instability; physiologic monitoring; step-down unit