Xandar Kardian Documentation
v2.6.7
Kardian Health Insights · POBC
POBC (Probability of Baseline Change) compares each resident's last 24 hours of respiratory and heart rate with their own recent baseline. These 190 cases, from long-term care residents monitored with the XK300, show the alarms that came before hospital transfers, new diagnoses and end-of-life care, and what happened next.
한국어: POBC 사용 사례
How to read a case
Each card shows the resident's daily respiratory and heart rate for the seven days before the event, the same way the Insights dashboard shows the last week. The dotted vertical line marks the event. For new diagnoses, the shaded area shows the days after.
Daily averageResident's own baselinePOBC alarm, rise (+80 or higher)POBC alarm, fall (−80 or lower)
Patterns
The same shapes came up again and again. Respiratory rate was more often the earlier and more telling signal than heart rate.
| Pattern | What often followed | |
|---|---|---|
| Respiratory rate rising for three or more days | Pneumonia, COVID-19, COPD exacerbation, low oxygen | See cases |
| Respiratory and heart rate rising together | Sepsis, fever, urinary tract infection, skin infection | See cases |
| Heart rate rising on its own | Abnormal vital signs, chest pain, high blood sugar, pain | See cases |
| Respiratory or heart rate falling below baseline | Altered mental status, weakness, fainting | See cases |
| Respiratory rate climbing steeply over the last two or three days | End of life | See cases |
| Values dropping below baseline after a diagnosis | Recovery after treatment | See cases |
Alarms on several days in a row deserve the most attention. A single alarm day is often a passing change, such as a poor night or a short-lived illness.
19 cases
Respiratory rate climbs a few breaths per minute above the resident's baseline and stays there for several days before a transfer or diagnosis. This was the most common pattern in the data.
Alarms five days in a row. Respiratory rate up on 4 days, to 32 breaths per minute (baseline 22); heart rate down on 1 day, to 64 bpm (baseline 81).
What followed. Respiratory failure or COPD exacerbation diagnosed. Afterwards values fell below baseline, the recovery pattern.
Alarms three days in a row. Respiratory rate down on 3 days, to 10 (baseline 16); heart rate up on 1 day, to 95 bpm (baseline 73).
What followed. Respiratory failure or COPD exacerbation diagnosed. Alarms continued after the diagnosis.
Alarms four days in a row. Respiratory rate up on 4 days, to 22 breaths per minute (baseline 15).
What followed. Transferred to hospital for low oxygen. Returned on day 3.
Alarms three days in a row. Respiratory rate up on 4 days, to 31 breaths per minute (baseline 24).
What followed. Transferred to hospital for low oxygen. Returned on day 3.
Alarms four days in a row. Respiratory rate down on 4 days, to 14 (baseline 23).
What followed. Respiratory failure or COPD exacerbation diagnosed. Alarms continued after the diagnosis.
Alarms four days in a row. Respiratory rate up on 4 days, to 33 breaths per minute (baseline 19).
What followed. Transferred to hospital for shortness of breath. Returned on day 7.
Respiratory rate up on 3 days, to 20 breaths per minute (baseline 14); heart rate up on 1 day, to 101 bpm (baseline 67).
What followed. Pneumonia diagnosed.
Alarms four days in a row. Respiratory rate up on 4 days, to 24 breaths per minute (baseline 16); heart rate up on 2 days, to 96 bpm (baseline 83).
What followed. Pneumonia diagnosed. Afterwards values fell below baseline, the recovery pattern.
Alarms three days in a row. Respiratory rate up on 3 days, to 30 breaths per minute (baseline 23); heart rate up on 1 day, to 88 bpm (baseline 80).
What followed. Pneumonia diagnosed. Alarms continued after the diagnosis.
Respiratory rate up on 2 days, to 25 breaths per minute (baseline 19); heart rate up on 1 day, to 75 bpm (baseline 58).
What followed. Pneumonia diagnosed.
Respiratory rate up on 2 days, to 30 breaths per minute (baseline 14); heart rate up on 1 day, to 81 bpm (baseline 73); heart rate down on 1 day, to 70 bpm (baseline 78).
What followed. Pneumonia diagnosed.
Alarms three days in a row. Respiratory rate up on 3 days, to 28 breaths per minute (baseline 21); heart rate up on 1 day, to 88 bpm (baseline 73).
What followed. Pneumonia diagnosed. Afterwards values fell below baseline, the recovery pattern.
Respiratory rate up on 3 days, to 18 breaths per minute (baseline 13); heart rate up on 1 day, to 91 bpm (baseline 80).
What followed. Transferred to hospital for shortness of breath.
Alarms three days in a row. Respiratory rate up on 2 days, to 24 breaths per minute (baseline 17); heart rate up on 1 day, to 87 bpm (baseline 64).
What followed. Respiratory failure or COPD exacerbation diagnosed.
Alarms three days in a row. Respiratory rate up on 3 days, to 30 breaths per minute (baseline 23).
What followed. Respiratory failure or COPD exacerbation diagnosed.
Respiratory rate up on 3 days, to 20 breaths per minute (baseline 15).
What followed. Pneumonia diagnosed.
Respiratory rate up on 3 days, to 20 breaths per minute (baseline 12); heart rate up on 1 day, to 117 bpm (baseline 88).
What followed. Respiratory failure or COPD exacerbation diagnosed.
Respiratory rate up on 1 day, to 17 breaths per minute (baseline 14); heart rate down on 2 days, to 59 bpm (baseline 83).
What followed. Pneumonia diagnosed. Transferred to hospital around the same time. Alarms continued after the diagnosis.
Alarms three days in a row. Respiratory rate up on 3 days, to 29 breaths per minute (baseline 22).
What followed. Transferred to hospital for shortness of breath. Returned on day 4.
20 cases
Respiratory rate often rose before COVID-19 was recorded, sometimes after an earlier change in heart rate, and kept rising for a few days afterwards.
Alarms four days in a row. Respiratory rate up on 3 days, to 16 breaths per minute (baseline 13); heart rate up on 1 day, to 88 bpm (baseline 78).
What followed. COVID-19 diagnosed.
Alarms four days in a row. Heart rate down on 4 days, to 64 bpm (baseline 87).
What followed. COVID-19 diagnosed.
Respiratory rate up on 3 days, to 21 breaths per minute (baseline 15); heart rate up on 1 day, to 98 bpm (baseline 80); heart rate down on 1 day, to 64 bpm (baseline 79).
What followed. COVID-19 diagnosed. Afterwards values fell below baseline, the recovery pattern.
Respiratory rate up on 2 days, to 29 breaths per minute (baseline 20); respiratory rate down on 1 day, to 16 (baseline 23).
What followed. COVID-19 diagnosed.
Respiratory rate up on 2 days, to 23 breaths per minute (baseline 18); heart rate up on 1 day, to 87 bpm (baseline 63).
What followed. COVID-19 diagnosed. Alarms continued after the diagnosis.
Alarms three days in a row. Respiratory rate up on 3 days, to 23 breaths per minute (baseline 18); heart rate up on 1 day, to 82 bpm (baseline 69).
What followed. COVID-19 diagnosed. Afterwards values fell below baseline, the recovery pattern.
Respiratory rate up on 2 days, to 22 breaths per minute (baseline 19); respiratory rate down on 1 day, to 17 (baseline 19).
What followed. COVID-19 diagnosed.
Alarms three days in a row. Respiratory rate up on 3 days, to 25 breaths per minute (baseline 20); heart rate up on 1 day, to 97 bpm (baseline 72).
What followed. COVID-19 diagnosed.
Alarms three days in a row. Respiratory rate up on 2 days, to 35 breaths per minute (baseline 25); respiratory rate down on 1 day, to 22 (baseline 25).
What followed. COVID-19 diagnosed.
Alarms three days in a row. Respiratory rate down on 3 days, to 11 (baseline 18).
What followed. COVID-19 diagnosed.
Alarms three days in a row. Respiratory rate up on 3 days, to 16 breaths per minute (baseline 13).
What followed. COVID-19 diagnosed.
Alarms three days in a row. Respiratory rate up on 1 day, to 23 breaths per minute (baseline 20); heart rate up on 2 days, to 86 bpm (baseline 78).
What followed. COVID-19 diagnosed.
Alarms three days in a row. Respiratory rate up on 1 day, to 21 breaths per minute (baseline 18); heart rate up on 2 days, to 70 bpm (baseline 61).
What followed. COVID-19 diagnosed. Alarms continued after the diagnosis.
Respiratory rate up on 2 days, to 22 breaths per minute (baseline 18); heart rate up on 1 day, to 90 bpm (baseline 63).
What followed. COVID-19 diagnosed.
Respiratory rate up on 2 days, to 23 breaths per minute (baseline 17); heart rate up on 1 day, to 81 bpm (baseline 67).
What followed. COVID-19 diagnosed.
Respiratory rate up on 2 days, to 18 breaths per minute (baseline 15).
What followed. COVID-19 diagnosed.
Respiratory rate up on 2 days, to 17 breaths per minute (baseline 14).
What followed. COVID-19 diagnosed. Alarms continued after the diagnosis.
Respiratory rate up on 2 days, to 20 breaths per minute (baseline 16).
What followed. COVID-19 diagnosed.
Heart rate down on 2 days, to 66 bpm (baseline 79).
What followed. COVID-19 diagnosed.
Heart rate down on 2 days, to 65 bpm (baseline 88).
What followed. COVID-19 diagnosed.
18 cases
Respiratory and heart rate rising together, often over consecutive days. Heart rate rises were larger than in respiratory infections alone.
Alarms four days in a row. Respiratory rate up on 1 day, to 24 breaths per minute (baseline 18); heart rate down on 4 days, to 61 bpm (baseline 100).
What followed. Cellulitis diagnosed. Alarms continued after the diagnosis.
Alarms four days in a row. Respiratory rate up on 1 day, to 20 breaths per minute (baseline 15); respiratory rate down on 1 day, to 12 (baseline 18); heart rate up on 2 days, to 81 bpm (baseline 59).
What followed. Cellulitis diagnosed. Alarms continued after the diagnosis.
Alarms three days in a row. Respiratory rate up on 3 days, to 23 breaths per minute (baseline 17); heart rate up on 2 days, to 112 bpm (baseline 85).
What followed. Sepsis diagnosed.
Alarms three days in a row. Respiratory rate up on 3 days, to 31 breaths per minute (baseline 18); heart rate up on 2 days, to 90 bpm (baseline 61).
What followed. Sepsis diagnosed. Afterwards values fell below baseline, the recovery pattern.
Respiratory rate up on 3 days, to 30 breaths per minute (baseline 20).
What followed. Sepsis diagnosed.
Alarms three days in a row. Respiratory rate up on 2 days, to 24 breaths per minute (baseline 18); heart rate up on 2 days, to 82 bpm (baseline 69).
What followed. Sepsis diagnosed.
Respiratory rate up on 2 days, to 26 breaths per minute (baseline 21); heart rate up on 1 day, to 109 bpm (baseline 81).
What followed. Sepsis diagnosed.
Respiratory rate up on 2 days, to 24 breaths per minute (baseline 12); heart rate up on 2 days, to 116 bpm (baseline 84).
What followed. Sepsis diagnosed. Alarms continued after the diagnosis.
Respiratory rate up on 1 day, to 23 breaths per minute (baseline 20); heart rate up on 1 day, to 99 bpm (baseline 81).
What followed. Sepsis diagnosed. Alarms continued after the diagnosis.
Respiratory rate up on 1 day, to 22 breaths per minute (baseline 17); heart rate up on 1 day, to 85 bpm (baseline 68); heart rate down on 1 day, to 63 bpm (baseline 71).
What followed. Sepsis diagnosed.
Respiratory rate up on 2 days, to 24 breaths per minute (baseline 21).
What followed. Transferred to hospital for infection.
Heart rate up on 1 day, to 85 bpm (baseline 76); heart rate down on 1 day, to 69 bpm (baseline 79).
What followed. Cellulitis diagnosed. Alarms continued after the diagnosis.
Respiratory rate up on 2 days, to 26 breaths per minute (baseline 19).
What followed. Sepsis diagnosed.
Respiratory rate up on 1 day, to 37 breaths per minute (baseline 28); respiratory rate down on 1 day, to 27 (baseline 36); heart rate down on 1 day, to 52 bpm (baseline 84).
What followed. Sepsis diagnosed. Transferred to hospital around the same time.
Respiratory rate up on 2 days, to 28 breaths per minute (baseline 20); heart rate up on 1 day, to 82 bpm (baseline 66).
What followed. Cellulitis diagnosed.
Respiratory rate up on 2 days, to 21 breaths per minute (baseline 14); heart rate up on 1 day, to 96 bpm (baseline 65).
What followed. Transferred to hospital for fever. Returned on day 3.
Respiratory rate up on 1 day, to 20 breaths per minute (baseline 18); heart rate up on 2 days, to 87 bpm (baseline 75).
What followed. Cellulitis diagnosed.
Respiratory rate up on 2 days, to 25 breaths per minute (baseline 17); heart rate up on 1 day, to 103 bpm (baseline 83).
What followed. Transferred to hospital for fever.
18 cases
Rising respiratory and heart rate a few days ahead of a urinary tract infection or kidney problem. Some cases show the recovery pattern after treatment.
Alarms six days in a row. Respiratory rate up on 2 days, to 30 breaths per minute (baseline 22); respiratory rate down on 3 days, to 18 (baseline 23); heart rate up on 2 days, to 108 bpm (baseline 94).
What followed. Acute kidney injury diagnosed.
Alarms three days in a row. Respiratory rate up on 2 days, to 29 breaths per minute (baseline 24); respiratory rate down on 3 days, to 23 (baseline 33).
What followed. Urinary tract infection diagnosed.
Alarms four days in a row. Respiratory rate up on 4 days, to 29 breaths per minute (baseline 22).
What followed. Urinary tract infection diagnosed.
Alarms three days in a row. Respiratory rate up on 3 days, to 21 breaths per minute (baseline 10).
What followed. Acute kidney injury diagnosed. Alarms continued after the diagnosis.
Alarms three days in a row. Respiratory rate up on 3 days, to 19 breaths per minute (baseline 14).
What followed. Acute kidney injury diagnosed.
Alarms three days in a row. Respiratory rate up on 1 day, to 18 breaths per minute (baseline 17); respiratory rate down on 1 day, to 14 (baseline 17); heart rate up on 1 day, to 95 bpm (baseline 67).
What followed. Acute kidney injury diagnosed.
Respiratory rate up on 2 days, to 16 breaths per minute (baseline 14); heart rate up on 1 day, to 95 bpm (baseline 59).
What followed. Urinary tract infection diagnosed.
Alarms three days in a row. Respiratory rate up on 2 days, to 19 breaths per minute (baseline 16); heart rate up on 2 days, to 87 bpm (baseline 65).
What followed. Urinary tract infection diagnosed.
Respiratory rate up on 3 days, to 24 breaths per minute (baseline 17).
What followed. Acute kidney injury diagnosed.
Alarms three days in a row. Respiratory rate up on 3 days, to 27 breaths per minute (baseline 21); heart rate up on 1 day, to 89 bpm (baseline 77).
What followed. Urinary tract infection diagnosed. Afterwards values fell below baseline, the recovery pattern.
Respiratory rate up on 2 days, to 21 breaths per minute (baseline 17); heart rate up on 1 day, to 78 bpm (baseline 60).
What followed. Urinary tract infection diagnosed. Alarms continued after the diagnosis.
Respiratory rate up on 2 days, to 22 breaths per minute (baseline 17); heart rate up on 1 day, to 77 bpm (baseline 51).
What followed. Acute kidney injury diagnosed.
Alarms three days in a row. Respiratory rate up on 1 day, to 19 breaths per minute (baseline 16); heart rate up on 2 days, to 116 bpm (baseline 90).
What followed. Urinary tract infection diagnosed.
Respiratory rate up on 3 days, to 24 breaths per minute (baseline 20).
What followed. Urinary tract infection diagnosed. Alarms continued after the diagnosis.
Respiratory rate up on 2 days, to 28 breaths per minute (baseline 20); heart rate up on 2 days, to 91 bpm (baseline 73).
What followed. Urinary tract infection diagnosed. Afterwards values fell below baseline, the recovery pattern.
Respiratory rate up on 1 day, to 20 breaths per minute (baseline 18); heart rate up on 1 day, to 84 bpm (baseline 77).
What followed. Urinary tract infection diagnosed.
Respiratory rate up on 1 day, to 25 breaths per minute (baseline 19); heart rate down on 1 day, to 44 bpm (baseline 61).
What followed. Acute kidney injury diagnosed.
Respiratory rate up on 1 day, to 25 breaths per minute (baseline 21); respiratory rate down on 1 day, to 19 (baseline 22); heart rate down on 1 day, to 71 bpm (baseline 100).
What followed. Urinary tract infection diagnosed.
20 cases
Here heart rate usually led. Sustained heart rate rises preceded transfers for abnormal vital signs, chest pain or edema; a sharp drop preceded fainting.
Alarms five days in a row. Heart rate up on 5 days, to 103 bpm (baseline 69).
What followed. Transferred to hospital for an abnormal vital signs.
Alarms four days in a row. Respiratory rate down on 1 day, to 19 (baseline 23); heart rate up on 3 days, to 90 bpm (baseline 61).
What followed. Transferred to hospital for an abnormal vital signs.
Alarms three days in a row. Respiratory rate up on 4 days, to 34 breaths per minute (baseline 24).
What followed. Transferred to hospital for an abnormal vital signs. Returned on day 2.
Alarms four days in a row. Respiratory rate up on 2 days, to 22 breaths per minute (baseline 17); heart rate down on 2 days, to 61 bpm (baseline 79).
What followed. Transferred to hospital for an abnormal vital signs.
Alarms three days in a row. Respiratory rate up on 3 days, to 26 breaths per minute (baseline 20).
What followed. Transferred to hospital for edema. Returned on day 5.
Respiratory rate up on 2 days, to 21 breaths per minute (baseline 16); heart rate up on 1 day, to 95 bpm (baseline 80).
What followed. Transferred to hospital for an abnormal vital signs.
Respiratory rate up on 2 days, to 21 breaths per minute (baseline 16); heart rate up on 1 day, to 88 bpm (baseline 72).
What followed. Transferred to hospital for blood clot.
Respiratory rate down on 1 day, to 13 (baseline 16); heart rate down on 3 days, to 47 bpm (baseline 84).
What followed. Transferred to hospital for fainting. Returned on day 8.
Respiratory rate up on 2 days, to 17 breaths per minute (baseline 13); heart rate up on 1 day, to 89 bpm (baseline 76).
What followed. Transferred to hospital for edema. Returned more than a week later.
Heart rate up on 2 days, to 86 bpm (baseline 64).
What followed. Transferred to hospital for chest pain.
Respiratory rate up on 2 days, to 27 breaths per minute (baseline 20).
What followed. Transferred to hospital for edema. Returned on day 5.
Alarms three days in a row. Heart rate down on 3 days, to 59 bpm (baseline 98).
What followed. Transferred to hospital for an abnormal vital signs.
Respiratory rate up on 2 days, to 23 breaths per minute (baseline 17); heart rate up on 1 day, to 117 bpm (baseline 88).
What followed. Transferred to hospital for an abnormal vital signs. Returned on day 3.
Respiratory rate up on 2 days, to 19 breaths per minute (baseline 15).
What followed. Transferred to hospital for chest pain.
Heart rate up on 1 day, to 95 bpm (baseline 85); heart rate down on 1 day, to 77 bpm (baseline 88).
What followed. Transferred to hospital for blood clot. Returned the same day.
Heart rate up on 2 days, to 87 bpm (baseline 69).
What followed. Transferred to hospital for an abnormal vital signs.
Respiratory rate up on 1 day, to 20 breaths per minute (baseline 16); heart rate up on 1 day, to 94 bpm (baseline 76).
What followed. Transferred to hospital for chest pain. Returned on day 3.
Respiratory rate up on 2 days, to 34 breaths per minute (baseline 22).
What followed. Transferred to hospital for an abnormal vital signs. Returned on day 5.
Respiratory rate up on 1 day, to 21 breaths per minute (baseline 14); heart rate up on 1 day, to 91 bpm (baseline 80).
What followed. Transferred to hospital for an abnormal vital signs.
Heart rate up on 2 days, to 98 bpm (baseline 81).
What followed. Transferred to hospital for an abnormal vital signs. Returned the next day.
17 cases
Transfers for abnormal lab results or blood sugar were often preceded by days of vital sign change, before the lab was drawn.
Alarms five days in a row. Respiratory rate up on 5 days, to 36 breaths per minute (baseline 22); heart rate up on 1 day, to 86 bpm (baseline 66).
What followed. Transferred to hospital for a high INR. Returned on day 2.
Respiratory rate down on 2 days, to 12 (baseline 16); heart rate down on 3 days, to 68 bpm (baseline 83).
What followed. Transferred to hospital for an abnormal lab result. Returned on day 7.
Alarms three days in a row. Respiratory rate up on 3 days, to 35 breaths per minute (baseline 28).
What followed. Transferred to hospital for high white blood cell count. Returned on day 4.
Alarms three days in a row. Respiratory rate up on 3 days, to 22 breaths per minute (baseline 16).
What followed. Transferred to hospital for an abnormal lab result. Returned on day 3.
Respiratory rate up on 3 days, to 30 breaths per minute (baseline 16).
What followed. Transferred to hospital for low hemoglobin.
Respiratory rate up on 2 days, to 22 breaths per minute (baseline 16); heart rate up on 1 day, to 90 bpm (baseline 73); heart rate down on 1 day, to 70 bpm (baseline 76).
What followed. Transferred to hospital for low blood sugar.
Respiratory rate up on 3 days, to 22 breaths per minute (baseline 16); heart rate down on 1 day, to 49 bpm (baseline 82).
What followed. Transferred to hospital for an abnormal X-ray.
Heart rate up on 3 days, to 107 bpm (baseline 76).
What followed. Transferred to hospital for high blood sugar. Returned on day 2.
Respiratory rate down on 2 days, to 15 (baseline 20); heart rate up on 1 day, to 86 bpm (baseline 70).
What followed. Transferred to hospital for low hemoglobin.
Heart rate down on 2 days, to 79 bpm (baseline 104).
What followed. Transferred to hospital for an abnormal lab result. Returned the same day.
Heart rate up on 1 day, to 94 bpm (baseline 72); heart rate down on 1 day, to 57 bpm (baseline 86).
What followed. Transferred to hospital for an abnormal lab result.
Respiratory rate up on 2 days, to 23 breaths per minute (baseline 18).
What followed. Transferred to hospital for high white blood cell count. Returned on day 2.
Respiratory rate up on 1 day, to 28 breaths per minute (baseline 22); heart rate up on 1 day, to 93 bpm (baseline 69).
What followed. Transferred to hospital for low blood sugar. Returned the same day.
Respiratory rate up on 1 day, to 25 breaths per minute (baseline 18); heart rate up on 1 day, to 116 bpm (baseline 82).
What followed. Transferred to hospital for an abnormal lab result.
Respiratory rate up on 2 days, to 18 breaths per minute (baseline 13); heart rate up on 1 day, to 85 bpm (baseline 70).
What followed. Transferred to hospital for high blood sugar. Returned on day 6.
Respiratory rate up on 2 days, to 18 breaths per minute (baseline 15).
What followed. Transferred to hospital for an abnormal lab result. Returned on day 4.
Respiratory rate down on 1 day, to 8 (baseline 11); heart rate up on 1 day, to 89 bpm (baseline 62); heart rate down on 1 day, to 54 bpm (baseline 61).
What followed. Transferred to hospital for low hemoglobin. Returned on day 6.
20 cases
Vomiting, bleeding, abdominal pain, poor intake and feeding-tube problems were often preceded by rising respiratory rate, sometimes with heart rate.
Alarms five days in a row. Respiratory rate up on 3 days, to 28 breaths per minute (baseline 16); respiratory rate down on 1 day, to 14 (baseline 19); heart rate up on 1 day, to 104 bpm (baseline 92); heart rate down on 2 days, to 68 bpm (baseline 96).
What followed. Transferred to hospital for feeding tube problem.
Alarms three days in a row. Respiratory rate up on 3 days, to 35 breaths per minute (baseline 24); respiratory rate down on 1 day, to 21 (baseline 23).
What followed. Transferred to hospital for feeding tube problem. Returned on day 2.
Respiratory rate up on 2 days, to 26 breaths per minute (baseline 16); respiratory rate down on 1 day, to 14 (baseline 16).
What followed. Transferred to hospital for constipation. Returned more than a week later.
Respiratory rate up on 2 days, to 26 breaths per minute (baseline 19); heart rate up on 1 day, to 115 bpm (baseline 91).
What followed. Transferred to hospital for poor intake. Returned the next day.
Alarms three days in a row. Respiratory rate up on 2 days, to 23 breaths per minute (baseline 17); heart rate up on 1 day, to 92 bpm (baseline 73).
What followed. Transferred to hospital for nausea and vomiting. Returned on day 3.
Respiratory rate up on 1 day, to 20 breaths per minute (baseline 13); heart rate up on 2 days, to 82 bpm (baseline 60).
What followed. Transferred to hospital for nausea and vomiting. Returned on day 3.
Respiratory rate down on 2 days, to 12 (baseline 27); heart rate up on 2 days, to 87 bpm (baseline 59).
What followed. Transferred to hospital for feeding tube problem.
Respiratory rate up on 1 day, to 25 breaths per minute (baseline 20); heart rate up on 2 days, to 91 bpm (baseline 64).
What followed. Transferred to hospital for abdominal pain. Returned on day 4.
Respiratory rate down on 2 days, to 13 (baseline 17).
What followed. Transferred to hospital for bleeding. Returned on day 2.
Respiratory rate up on 2 days, to 24 breaths per minute (baseline 17).
What followed. Transferred to hospital for poor intake. Returned more than a week later.
Heart rate up on 1 day, to 91 bpm (baseline 81); heart rate down on 1 day, to 70 bpm (baseline 85).
What followed. Transferred to hospital for abdominal pain.
Respiratory rate up on 2 days, to 29 breaths per minute (baseline 21).
What followed. Transferred to hospital for abdominal pain. Returned on day 4.
Respiratory rate up on 2 days, to 27 breaths per minute (baseline 18); heart rate up on 1 day, to 86 bpm (baseline 59).
What followed. Transferred to hospital for abdominal pain. Returned on day 8.
Respiratory rate up on 2 days, to 19 breaths per minute (baseline 15).
What followed. Transferred to hospital for bleeding.
Respiratory rate up on 2 days, to 21 breaths per minute (baseline 16).
What followed. Transferred to hospital for abdominal pain.
Respiratory rate up on 1 day, to 15 breaths per minute (baseline 11); heart rate up on 1 day, to 92 bpm (baseline 71).
What followed. Transferred to hospital for abdominal pain. Returned on day 4.
Respiratory rate up on 2 days, to 16 breaths per minute (baseline 13).
What followed. Transferred to hospital for diarrhea. Returned on day 8.
Respiratory rate up on 1 day, to 20 breaths per minute (baseline 17); heart rate up on 2 days, to 96 bpm (baseline 70).
What followed. Transferred to hospital for bleeding. Returned on day 4.
Respiratory rate down on 1 day, to 13 (baseline 16); heart rate up on 1 day, to 104 bpm (baseline 94).
What followed. Transferred to hospital for bleeding.
Heart rate up on 2 days, to 77 bpm (baseline 55).
What followed. Transferred to hospital for bleeding. Returned the same day.
20 cases
Not every warning is a rise. Falling respiratory or heart rate, or a mixed pattern, preceded many transfers for altered mental status or weakness.
Respiratory rate down on 2 days, to 13 (baseline 17); heart rate up on 2 days, to 93 bpm (baseline 78).
What followed. Transferred to hospital for altered mental status. Returned on day 4.
Alarms three days in a row. Respiratory rate down on 3 days, to 9 (baseline 12).
What followed. Transferred to hospital for weakness.
Alarms three days in a row. Respiratory rate down on 3 days, to 8 (baseline 18).
What followed. Transferred to hospital for altered mental status.
Respiratory rate up on 2 days, to 18 breaths per minute (baseline 14); heart rate up on 1 day, to 94 bpm (baseline 66).
What followed. Transferred to hospital for altered mental status.
Alarms three days in a row. Respiratory rate up on 3 days, to 15 breaths per minute (baseline 11); heart rate up on 3 days, to 109 bpm (baseline 80).
What followed. Transferred to hospital for weakness. Returned on day 5.
Respiratory rate up on 2 days, to 35 breaths per minute (baseline 22); heart rate up on 1 day, to 108 bpm (baseline 84); heart rate down on 1 day, to 80 bpm (baseline 95).
What followed. Transferred to hospital for altered mental status.
Respiratory rate up on 2 days, to 21 breaths per minute (baseline 16); respiratory rate down on 1 day, to 14 (baseline 17); heart rate up on 1 day, to 79 bpm (baseline 68).
What followed. Transferred to hospital for altered mental status. Returned on day 4.
Respiratory rate up on 2 days, to 22 breaths per minute (baseline 17); heart rate up on 2 days, to 98 bpm (baseline 88); heart rate down on 1 day, to 66 bpm (baseline 93).
What followed. Transferred to hospital for altered mental status.
Respiratory rate up on 2 days, to 19 breaths per minute (baseline 14); heart rate up on 2 days, to 102 bpm (baseline 82).
What followed. Transferred to hospital for altered mental status. Returned on day 4.
Respiratory rate down on 1 day, to 11 (baseline 14); heart rate up on 1 day, to 76 bpm (baseline 63).
What followed. Transferred to hospital for altered mental status. Returned on day 7.
Heart rate up on 1 day, to 93 bpm (baseline 80); heart rate down on 1 day, to 67 bpm (baseline 80).
What followed. Transferred to hospital for altered mental status.
Respiratory rate up on 1 day, to 29 breaths per minute (baseline 21); heart rate down on 1 day, to 73 bpm (baseline 93).
What followed. Transferred to hospital for altered mental status.
Respiratory rate up on 2 days, to 19 breaths per minute (baseline 13).
What followed. Transferred to hospital for altered mental status.
Respiratory rate down on 1 day, to 14 (baseline 18); heart rate down on 1 day, to 60 bpm (baseline 101).
What followed. Transferred to hospital for altered mental status.
Respiratory rate up on 2 days, to 17 breaths per minute (baseline 14).
What followed. Transferred to hospital for altered mental status.
Respiratory rate up on 1 day, to 22 breaths per minute (baseline 16); respiratory rate down on 1 day, to 12 (baseline 16); heart rate up on 2 days, to 88 bpm (baseline 62).
What followed. Transferred to hospital for altered mental status. Returned on day 3.
Respiratory rate down on 1 day, to 15 (baseline 22); heart rate down on 1 day, to 62 bpm (baseline 73).
What followed. Transferred to hospital for altered mental status. Returned the same day.
Respiratory rate up on 2 days, to 27 breaths per minute (baseline 17); heart rate up on 2 days, to 91 bpm (baseline 70).
What followed. Transferred to hospital for possible stroke.
Respiratory rate up on 2 days, to 15 breaths per minute (baseline 11).
What followed. Transferred to hospital for altered mental status. Returned on day 4.
Respiratory rate down on 1 day, to 22 (baseline 26); heart rate up on 1 day, to 71 bpm (baseline 57).
What followed. Transferred to hospital for altered mental status.
20 cases
Uncontrolled pain and worsening wounds tended to show as heart and respiratory rate rises. Falls are sudden, but in some residents vital signs had already shifted in the days before.
Respiratory rate down on 1 day, to 9 (baseline 16); heart rate up on 2 days, to 93 bpm (baseline 73); heart rate down on 2 days, to 66 bpm (baseline 87).
What followed. Transferred to hospital for wound or ulcer.
Respiratory rate up on 3 days, to 30 breaths per minute (baseline 15).
What followed. Transferred to hospital for wound or ulcer.
Respiratory rate up on 1 day, to 28 breaths per minute (baseline 23); heart rate up on 1 day, to 90 bpm (baseline 74); heart rate down on 1 day, to 68 bpm (baseline 87).
What followed. Transferred to hospital for wound or ulcer. Returned more than a week later.
Alarms three days in a row. Respiratory rate up on 2 days, to 21 breaths per minute (baseline 17); heart rate up on 1 day, to 91 bpm (baseline 77).
What followed. Transferred to hospital for uncontrolled pain.
Respiratory rate up on 2 days, to 21 breaths per minute (baseline 17); heart rate up on 1 day, to 82 bpm (baseline 74); heart rate down on 1 day, to 64 bpm (baseline 77).
What followed. Transferred to hospital after a fall. Returned the same day.
Alarms three days in a row. Heart rate up on 3 days, to 89 bpm (baseline 74).
What followed. Transferred to hospital for uncontrolled pain. Returned on day 8.
Respiratory rate up on 2 days, to 33 breaths per minute (baseline 20); heart rate down on 1 day, to 55 bpm (baseline 79).
What followed. Transferred to hospital after a fall. Returned on day 5.
Respiratory rate up on 2 days, to 20 breaths per minute (baseline 15); heart rate up on 2 days, to 114 bpm (baseline 76).
What followed. Transferred to hospital for wound or ulcer. Returned on day 10.
Heart rate up on 1 day, to 86 bpm (baseline 69); heart rate down on 1 day, to 62 bpm (baseline 76).
What followed. Transferred to hospital for wound or ulcer. Returned the same day.
Respiratory rate up on 1 day, to 20 breaths per minute (baseline 16); heart rate down on 1 day, to 72 bpm (baseline 85).
What followed. Transferred to hospital after a fall. Returned on day 6.
Heart rate up on 2 days, to 101 bpm (baseline 76).
What followed. Transferred to hospital after a fall. Returned the next day.
Respiratory rate up on 1 day, to 17 breaths per minute (baseline 16); heart rate down on 1 day, to 61 bpm (baseline 68).
What followed. Transferred to hospital for uncontrolled pain. Returned the next day.
Respiratory rate up on 1 day, to 20 breaths per minute (baseline 16); respiratory rate down on 1 day, to 14 (baseline 18).
What followed. Transferred to hospital after a fall.
Respiratory rate up on 1 day, to 21 breaths per minute (baseline 13); heart rate down on 1 day, to 55 bpm (baseline 75).
What followed. Transferred to hospital after a fall. Returned the same day.
Alarms three days in a row. Respiratory rate up on 2 days, to 28 breaths per minute (baseline 16); heart rate up on 3 days, to 79 bpm (baseline 61).
What followed. Transferred to hospital for uncontrolled pain. Returned on day 4.
Respiratory rate up on 1 day, to 18 breaths per minute (baseline 16); heart rate up on 1 day, to 83 bpm (baseline 57).
What followed. Transferred to hospital after a fall. Returned the same day.
Respiratory rate up on 2 days, to 19 breaths per minute (baseline 15).
What followed. Transferred to hospital for uncontrolled pain. Returned the next day.
Heart rate down on 2 days, to 51 bpm (baseline 67).
What followed. Transferred to hospital after a fall.
Respiratory rate up on 1 day, to 16 breaths per minute (baseline 11); heart rate up on 1 day, to 94 bpm (baseline 85).
What followed. Transferred to hospital for uncontrolled pain. Returned on day 3.
Respiratory rate up on 2 days, to 18 breaths per minute (baseline 12); heart rate up on 2 days, to 94 bpm (baseline 76).
What followed. Transferred to hospital for uncontrolled pain. Returned on day 6.
18 cases
Most deaths in the data were preceded by POBC alarms in the final days, usually a respiratory rate that climbed steeply over the last two or three days. Staff can use this time to prepare the resident, the family and the care team.
Alarms six days in a row. Respiratory rate up on 3 days, to 24 breaths per minute (baseline 16); respiratory rate down on 1 day, to 13 (baseline 16); heart rate up on 2 days, to 92 bpm (baseline 58).
What followed. Died.
Alarms four days in a row. Respiratory rate up on 2 days, to 20 breaths per minute (baseline 9); respiratory rate down on 2 days, to 9 (baseline 12); heart rate up on 2 days, to 107 bpm (baseline 82).
What followed. Died.
Alarms three days in a row. Respiratory rate up on 4 days, to 44 breaths per minute (baseline 30); heart rate down on 2 days, to 58 bpm (baseline 92).
What followed. Died.
Alarms four days in a row. Respiratory rate up on 4 days, to 20 breaths per minute (baseline 15).
What followed. Died.
Alarms four days in a row. Respiratory rate up on 3 days, to 40 breaths per minute (baseline 15); heart rate down on 2 days, to 53 bpm (baseline 92).
What followed. Died.
Respiratory rate up on 2 days, to 26 breaths per minute (baseline 13); respiratory rate down on 1 day, to 11 (baseline 14); heart rate up on 1 day, to 83 bpm (baseline 71); heart rate down on 1 day, to 56 bpm (baseline 76).
What followed. Died.
Respiratory rate up on 1 day, to 19 breaths per minute (baseline 15); heart rate up on 2 days, to 91 bpm (baseline 74); heart rate down on 1 day, to 70 bpm (baseline 85).
What followed. Died.
Respiratory rate up on 1 day, to 19 breaths per minute (baseline 11); heart rate up on 1 day, to 79 bpm (baseline 64); heart rate down on 2 days, to 64 bpm (baseline 82).
What followed. Died.
Respiratory rate up on 2 days, to 32 breaths per minute (baseline 13); heart rate up on 1 day, to 62 bpm (baseline 57).
What followed. Died.
Respiratory rate up on 2 days, to 24 breaths per minute (baseline 17); heart rate up on 1 day, to 98 bpm (baseline 72).
What followed. Died.
Respiratory rate up on 3 days, to 48 breaths per minute (baseline 33); heart rate down on 1 day, to 49 bpm (baseline 85).
What followed. Died.
Respiratory rate up on 1 day, to 20 breaths per minute (baseline 14); heart rate up on 1 day, to 87 bpm (baseline 77); heart rate down on 1 day, to 73 bpm (baseline 82).
What followed. Died.
Respiratory rate up on 3 days, to 22 breaths per minute (baseline 13).
What followed. Died.
Respiratory rate up on 1 day, to 26 breaths per minute (baseline 18); heart rate up on 1 day, to 106 bpm (baseline 70); heart rate down on 2 days, to 67 bpm (baseline 104).
What followed. Died.
Alarms three days in a row. Respiratory rate up on 3 days, to 33 breaths per minute (baseline 13); heart rate down on 1 day, to 78 bpm (baseline 98).
What followed. Died.
Respiratory rate up on 3 days, to 18 breaths per minute (baseline 14).
What followed. Died.
Alarms three days in a row. Respiratory rate up on 3 days, to 29 breaths per minute (baseline 14); heart rate up on 1 day, to 85 bpm (baseline 76).
What followed. Died.
Alarms three days in a row. Respiratory rate up on 3 days, to 31 breaths per minute (baseline 21); heart rate up on 1 day, to 103 bpm (baseline 86).
What followed. Died.
About these cases
Not a diagnosis. POBC indicates that a resident's vital signs have changed from their own baseline and that a check may be worthwhile. It does not identify a condition. Clinical assessment and decisions remain with the care team.