Patient Safety: Other Complications of Hospital Care

Measure Title

Composite measure: Bloodstream infections (BSIs) or mechanical adverse events associated with central venous catheters (CVCs).

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Table

165 Percent of central venous catheter placement with associated bloodstream infections or mechanical adverse events, United States, 2005

Data Source

CMS, MPSMS.

Denominator

All discharges from the MPSMS sample with documentation of placement of at least one vascular access device, or CVC, terminating at, or close to, the heart or in one of the great vessels. The following are considered great vessels for this measure: aorta, vena cava, brachiocephalic veins, iliac vein, internal jugular veins, and subclavian veins that did not have evidence of a prior BSI.

Numerator

Subset of the denominator with either a CVC-associated bloodstream infection or CVC-associated mechanical adverse events.

Comments

See entries for each of the components of the composite measure for further details about the methodology.

Measure Title

Bloodstream infections (BSIs) associated with central venous catheters (CVCs).

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Table

166 Percent of discharges with central venous catheter placement with associated bloodstream infections, United States, 2005

Data Source

CMS, MPSMS.

Denominator

All discharges from the MPSMS sample with record of placement of at least one vascular access device, or CVC, terminating at, or close to, the heart or in one of the great vessels. The following are considered great vessels for this measure: aorta, vena cava, brachiocephalic veins, iliac vein, internal jugular veins, and subclavian veins.

Numerator

Subset of the denominator with CVC-associated BSI.

Comments

CVC-associated BSI is determined by documentation of all of the following:

(1) At least one blood culture, drawn at least 2 days after placement of a CVC and positive for at least one of the following pathogens: Staphylococcus Aureus, Escherichia Coli, Coagulase negative Staphylococcus, Enterococcus species, Klebsiella species, Pseudomonas Aeruginosa, beta-hemolytic Streptococcus, Enterobacter species, Viridans-group Streptococci, Candida and all other fungi, atypical mycobacteria, Acinetobacter, Citrobacter freundii, Proteus mirabilis, and Serratia marcescens;

(2) No other source of infection documented;

(3) At least one of the following: Temperature > 100.4ºF or <96.8ºF, white blood cell count >12,000 or < 4000/hpf, band Neutrophils > 10% of white blood cell count, and hypotension.

Measure Title

Mechanical adverse events associated with central venous catheters (CVCs).

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Table

167 Percent of central venous catheter placement with associated mechanical adverse events, United States, 2005

Data Source

CMS, MPSMS.

Denominator

All instances in records from the MPSMS sample of placement of at least one vascular access device terminating at, or close to, the heart or in one of the great vessels. The following are considered great vessels for this measure: aorta, vena cava, brachiocephalic veins, iliac vein, internal jugular veins, and subclavian veins.

Numerator

Subset of the denominator with CVC-associated mechanical adverse events.

Comments

A CVC-associated mechanical adverse event is defined as the presence in the medical record of at least one of the following: allergic reaction, tamponade, perforation, pneumothorax, hematoma, shearing off of the catheter, air embolism, misplaced catheter, thrombosis/embolism, knotting of the pulmonary artery catheter, arrhythmia requiring treatment during insertion, bleeding, equipment malfunction, and pain.

Measure Title

Selected infections due to medical care per 1,000 discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSI).

Table

169 Selected infections due to medical care per 1,000 medical and surgical discharges (excluding immunocompromised and cancer patients, stays under 2 days, and admissions specifically for such infections), age 18 and over or obstetric admissions, by

• Ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

All medical and surgical hospital discharges, excluding immunocompromised and cancer patients and neonates.

Numerator

All medical and surgical hospital discharges with any secondary diagnosis of infection (ICD-9-CM diagnosis code 999.3 or 996.62), excluding immunocompromised or cancer patients.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Group (DRG) clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 7 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Measure Title

Deaths per 1,000 discharges with complications potentially resulting from care (failure to rescue).

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSI).

Table

170 Failure to rescue or deaths per 1,000 discharges having developed specified complications of care during hospitalization (excluding patients transferred in or out, patients admitted from long-term care facilities), ages 18-74, United States, by

• Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

Inpatient hospital discharges with potential complications of care listed in failure to rescue definition (i.e., pneumonia, deep vein thrombosis/pulmonary embolism, sepsis, acute renal failure, shock/cardiac arrest, or gastrointestinal hemorrhage/acute ulcer), excluding patients transferred in or out, patients admitted from long-term-care facilities, neonates, and patients over 74 years old.

Numerator

Subset of the denominator with discharge disposition of "death."

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Group (DRG) clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 4 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Measure Title

Accidental laceration or puncture during procedure per 1,000 discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSI).

Table

171 Accidental puncture or laceration during procedures per 1,000 discharges (excluding obstetric admissions), age 18 and over, United States, 2004, by

• Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

Hospital medical and surgical discharges, excluding obstetric admissions.

Numerator

Non-maternal medical and surgical discharges with any secondary diagnosis denoting technical difficulty (e.g., accidental cut, puncture, perforation, or laceration during a procedure).

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Group (DRG) clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 15 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Measure Title

Iatrogenic pneumothorax per 1,000 relevant discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSI).

Table

172 Iatrogenic pneumothorax per 1,000 discharges (excluding obstetrical admissions and patients with trauma, thoracic surgery, lung or pleural biopsy, or cardiac surgery), age 18 and over, United States, 2004, by

• Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

All non-maternal/non-neonatal medical and surgical hospital discharges, excluding patients with trauma, thoracic surgery, lung or pleural biopsy, or cardiac surgery.

Numerator

Non-neonatal/non-maternal medical and surgical discharges with any secondary diagnosis of iatrogenic pneumothorax (ICD-9-CM diagnosis code 512.1,) excluding patients with trauma, thoracic surgery, lung or pleural biopsy, or cardiac surgery.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Group (DRG) clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 6 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Measure Title

Deaths per 1,000 admissions in low-mortality DRGs.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSI).

Table

173 Deaths per 1,000 admissions in low-mortality DRGs (DRGs with a NIS [Nationwide Inpatient Sample] 1997 benchmark of less than 0.5% mortality, excluding trauma, immunocompromised, and cancer patients), age 18 and over or obstetric admissions, United States, 2004, by

• Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

Hospital admissions in low mortality Diagnosis Related Groups (DRGs), excluding trauma, immunocompromised, and cancer patients.

Numerator

Subset of the denominator with discharge disposition of "death."

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Group (DRG) clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 2 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Measure Title

Percent of community-dwelling elderly who had at least 1 prescription (from a list of 11 medications and from a list of 33 medications) that is potentially inappropriate for the elderly.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Quality Improvement and Patient Safety (CQUIPS).

Tables

174a Adults age 65 and over with at least 1 prescription from 33 medications that are inappropriate, United States, 2004, by

• Race.
• Ethnicity.
• Family income.
• Education.

174b Adults age 65 and over with at least 1 prescription from 11 medications that should always be avoided, United States, 2004, by

• Race.
• Ethnicity.
• Family income.
• Education.

Data Source

AHRQ, Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Denominator

U.S. population age 65 and over.

Numerator

Persons age 65 and over who had 1 or more of the 11 or 33 potentially inappropriate medications.

Comments

For additional information concerning potentially inappropriate medications, see Zhan C, Sangl J, Bierman AS, Miller MR, Friedman B, Wickzier SW, Meyer GS. Potentially Inappropriate Medication Use in the Community-Dwelling Elderly: Findings from 1996 Medical Expenditure Panel Survey, Journal of American Medical Association, 286(22), 2823-2829, 2001.

Measure Title

Adverse drug events: Anticoagulant: Warfarin.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Table

175 Percent of patients with adverse drug events: anticoagulant-related warfarin, United States, 2005

Data Source

CMS, MPSMS.

Denominator

All discharges from the MPSMS sample administered warfarin during the index hospital stay.

Numerator

Subset of denominator with a documented adverse reaction to the indicated medication.

Measure Title

Adverse drug events: Anticoagulant: IV heparin.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Table

176 Percent of patients with adverse drug events: anticoagulant-related IV heparin, United States, 2005

Data Source

CMS, MPSMS.

Denominator

All discharges from the MPSMS sample administered IV heparin during the index hospital stay.

Numerator

Subset of denominator with a documented adverse reaction to the indicated medication.

Measure Title

Adverse drug events: Anticoagulant: low-molecular-weight heparin (LMWH) and factor Xa.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Table

177 Percent of patients with adverse drug events: anticoagulant-related low-molecular-weight heparin and factor Xa, United States, 2005

Data Source

CMS, MPSMS.

Denominator

All discharges from the MPSMS sample administered LMWH and factor Xa during the index hospital stay.

Numerator

Subset of denominator with a documented adverse reaction to the indicated medication.

Measure Title

Adverse drug events: Hypoglycemic agents: Insulin/oral hypoglycemics/combination of both.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Table

178 Percent of patients with adverse drug events: hypoglycemic agents including insulin, oral hypoglycemic, or combination of both, United States, 2005

Data Source

CMS, MPSMS.

Denominator

All discharges from the MPSMS sample administered insulin, oral hypoglycemics, or a combination of both during the index hospital stay.

Numerator

Subset of denominator with a documented adverse reaction to the indicated medication.

Measure Title

Birth trauma injury per 1,000 selected live births.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSI).

Table

179 Birth trauma—injury to neonate per 1,000 live births (excluding preterm and osteogenesis imperfecta births), United States, 2004, by

• Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

Live birth discharges in the United States, excluding preterm and osteogenesis imperfecta births.

Numerator

Subset of the denominator with any diagnosis of birth trauma.

Comments

Rates are adjusted by gender. When reporting is by gender, there is no adjustment.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 17 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

This measure and its tables are also presented in other relevant sections of the report.

Measure Title

Obstetric trauma per 1,000 instrument-assisted deliveries.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSI).

Table

180 Obstetric trauma with 3rd or 4th degree lacerations per 1,000 instrument-assisted vaginal deliveries, United States, 2004, by

• Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

All vaginal delivery hospital discharges with any procedure indicating instrument-assisted delivery.

Numerator

Subset of the denominator with any diagnosis or procedure indicating obstetric trauma.

Comments

Rates are adjusted by age. When reporting is by age, there is no adjustment.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 27 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

This measure and its tables are also presented in other relevant sections of the report.

Measure Title

Obstetric trauma per 1,000 vaginal deliveries without instrument assistance.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSI).

Table

181 Obstetric trauma with 3rd or 4th degree lacerations per 1,000 vaginal deliveries without instrument assistance, United States, 2004, by

• Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

All vaginal delivery hospital discharges without indication of instrument assistance.

Numerator

Subset of the denominator with any diagnosis or procedure indicating obstetric trauma.

Comments

Rates are adjusted by age. When reporting is by age, there is no adjustment.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 28 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

This measure and its tables are also presented in other relevant sections of the report.

Measure Title

Obstetric trauma per 1,000 cesarean deliveries.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSI).

Table

182 Obstetric trauma with 3rd or 4th degree lacerations per 1,000 cesarean deliveries, United States, 2004, by

• Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

All cesarean section delivery hospital discharges.

Numerator

Cesarean section delivery discharges with any diagnosis or procedure indicating obstetric trauma.

Comments

Rates are adjusted by age. When reporting is by age, there is no adjustment.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 29 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

This measure and its tables are also presented in other relevant sections of the report.