Patient Safety Indicators is one of the four Quality Indicators (QI) developed by the Agency For Healthcare Research and Quality (AHRQ). These are a set of indicators providing information on hospital complications and adverse events during clinical procedures, surgeries, and childbirth. The AHRQ QIs use software to identify the adverse events or complications which needs further study in order to improve the healthcare quality. They use the readily available administrative data from typical discharge records to identify the adverse events. The Patient safety indicators are defined on two levels- Provider level and Area level. The Provider-level indicators are measures of preventable adverse events and complications in patients receiving their initial care and hospitalization. The Area level indicators are potentially preventable complications that occur in a given area.
PSI (Patient Safety Indicators) composite measure summarizes quality across multiple indicators and helps to monitor healthcare quality over time or across regions and populations using a method that applied at the national, regional, State or provider/area level.
AHRQ PSI Composite Measure #90 includes Patient Safety for Selected Indicators.
PSI Code is PSI90 and PSI Value is Patient Safety for Selected Indicators.
– Composite measure (PSI90) includes:
– PSI #03 Pressure Ulcer
– PSI #06 Iatrogenic Pneumothorax
– PSI #07 Central Venous Catheter-related Bloodstream Infections
– PSI #08 Postop Hip Fracture
– PSI #09 Postop Hemorrhage or Hematoma
– PSI #10 Postop Physiologic and Metabolic Derangements
– PSI #11 Postop Respiratory Failure
– PSI #12 Postop PE or DVT
– PSI #13 Postop Sepsis
– PSI #14 Postop Wound Dehiscence
– PSI #15 Accidental Puncture or Laceration
Steps in PSI composite calculation
– Observed Rate = Numerator/Denominator
– Numerator = No of cases with preventable complications or adverse event, Denominator= No of risk for the events
– Risk-Adjusted Rate = (Observed/Expected) * National Observed Rate
– Risk-adjusted rate is computed based on a hierarchical logistic regression model for calculating a predicted value for each case. Then the predicted values among all the cases in the hospital are averaged to compute the expected rate.
– Composite Rate = sum (Smoothed Rate * Weights) where sum of Weighted scores of different indicators are measured.
– Smoothed Rate = Adjusted Rate is “shrunk” to the National Risk-Adjusted Rate.