Patient Safety and Quality

AHRQ's patient safety indicators may be useful for comparing quality of care across delivery systems

A new study of Veterans Health Administration (VA) hospitals shows excess deaths, longer hospital stays, and higher costs in all groups of patients who experienced potentially preventable safety problems indicated by patient safety indicators (PSIs) developed by the Agency for Healthcare Research and Quality (AHRQ).

PSIs indicate preventable care-related problems such as hospital-acquired infections or post-operative respiratory failure. The study's findings were similar to a previous study of nonfederal community hospitals. Thus, AHRQ's PSIs may be useful for comparing care quality across delivery systems. AHRQ researcher, Anne Elixhauser, Ph.D., and colleagues applied 9 PSIs to all 439,537 acute inpatient hospitalizations at 125 VA hospitals. They then compared these findings with those based on similar data on PSIs and adverse events at U.S. community hospitals from AHRQ's Healthcare Cost and Utilization Project Nationwide Inpatient Sample. They controlled for patient and facility characteristics while predicting the effect of the PSI on mortality, length of stay (LOS), and cost. All nine PSIs were significantly associated with increased LOS, cost, and mortality in similar patterns among both VA and non-VA hospitals.

The three PSIs that occurred most often—decubitus ulcer, postoperative pulmonary embolism/deep vein thrombosis, and accidental puncture/laceration—were associated with relatively smaller excess mortality, LOS, and cost. The three PSIs that occurred least often—postoperative sepsis (blood infection), respiratory failure, and dehiscence (disruption of the wound) were associated with the greatest excess mortality, LOS, and cost.

See "Using patient safety indicators to estimate the impact of potential adverse events on outcomes," by Peter E. Rivard, Ph.D., Stephen L. Luther, Ph.D., Cindy L. Christiansen, Ph.D., and others, in the February 2008 Medical Care Research and Review 65(1), pp. 67-87.

Reprints (AHRQ Publication No. 08-R046) are available from the AHRQ Publications Clearinghouse.

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