Patient Safety Indicators Overview 

The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QIs) measure health care quality by using readily available hospital inpatient administrative data. The Patient Safety Indicators (PSIs) are a tool to help health system leaders identify potential adverse events occurring during hospitalization.

The PSIs are a set of indicators providing information on potential inhospital complications and adverse events following surgeries, procedures, and childbirth. The PSIs were developed after a comprehensive literature review, analysis of ICD-9-CM codes, review by a clinician panel, implementation of risk adjustment, and empirical analyses.

The PSIs are a software tool distributed free by AHRQ. The software can be used to help hospitals identify potential adverse events that might need further study. The PSI software programs can be applied to any hospital inpatient administrative data. These data are readily available and relatively inexpensive to use.

The PSIs form the third of a set of AHRQ QIs developed by investigators at Stanford University and the University of California, under a contract with AHRQ.

The AHRQ QIs expanded the original Healthcare Cost and Utilization Project (HCUP) QIs. The Prevention Quality Indicators, the first set of AHRQ QIs, were released in November 2001. The second set, the Inpatient Quality Indicators, were released in May 2002.  The PSIs were released in March 2003.  In February 2006, the fourth QI module, the Pediatric Quality Indicators,  was added while the pediatric population was removed from the other modules.

AHRQ is making the Patient Safety Indicators software available without charge to hospitals and other users as SAS® and SPSS® programs with software documentation and a user guide that provides a synopsis of the evidence taken from the "Measures of Patient Safety Based on Hospital Administrative Data."

PSI Facts

Patient Safety Indicators:

• Can be used to help hospitals identify potential adverse events that might need further study.
• Provide the opportunity to assess the incidence of adverse events and inhospital complications using administrative data found in the typical discharge record.
• Include 20 indicators for complications occurring inhospital that may represent patient safety events.
• Six indicators also have area level analogs designed to detect patient safety events on a regional level.
• Are free and publicly available.
• Are available for download.

The PSIs provide a perspective on patient safety events using hospital administrative data, which are readily available and relatively inexpensive to use, and include the following 27 measures:

1. Hospital-level Patient Safety Indicators (20 Indicators)
   • Complications of anesthesia (PSI 1)
   • Death in low mortality DRGs (PSI 2)
   • Decubitus ulcer (PSI 3)
   • Failure to rescue (PSI 4)
   • Foreign body left in during procedure (PSI 5)
   • Iatrogenic pneumothorax (PSI 6)
   • Selected infections due to medical care (PSI 7)
   • Postoperative hip fracture (PSI 8)
   • Postoperative hemorrhage or hematoma (PSI 9)
   • Postoperative physiologic and metabolic derangements (PSI 10)
   • Postoperative respiratory failure (PSI 11)
   • Postoperative pulmonary embolism or deep vein thrombosis (PSI 12)
   • Postoperative sepsis (PSI 13)
   • Postoperative wound dehiscence in abdominopelvic surgical patients (PSI 14)
   • Accidental puncture and laceration (PSI 15)
   • Transfusion reaction (PSI 16)
   • Birth trauma -- injury to neonate (PSI 17)
   • Obstetric trauma -- vaginal delivery with instrument (PSI 18)
   • Obstetric trauma -- vaginal delivery without instrument (PSI 19)
   • Obstetric trauma -- cesarean delivery (PSI 20)
      
2. Area-level Patient Safety Indicators (7 Indicators)
   • Foreign body left in during procedure (PSI 21)
   • Iatrogenic pneumothorax (PSI 22)
   • Selected infections due to medical care (PSI 23)
   • Postoperative wound dehiscence in abdominopelvic surgical patients (PSI 24)
   • Accidental puncture and laceration (PSI 25)
   • Transfusion reaction (PSI 26)
   • Post-operative hemorrhage or hematoma (PSI 27)