The Link Between Clinically Validated Patient Safety Indicators and Clinical Outcomes

2016 ◽  
Vol 32 (6) ◽  
pp. 583-590 ◽  
Author(s):  
Darrell M. Gray ◽  
Jennifer L. Hefner ◽  
Michelle C. Nguyen ◽  
Daniel Eiferman ◽  
Susan D. Moffatt-Bruce
Keyword(s):  
Patient Safety ◽  
Length Of Stay ◽  
Medical Center ◽  
Academic Medical Center ◽  
Strong Association ◽  
Unplanned Readmission ◽  
Policy And Practice ◽  
Patient Safety Indicators ◽  
Experience Of Care ◽  
Multivariable Regression Models

There is a paucity of evidence on the association between clinically validated Patient Safety Indicators (PSIs) and inpatient length of stay, mortality, and 30-day unplanned readmission. The authors perform a retrospective analysis of patient discharges from an academic medical center comprising 6 hospitals from July 2012 to June 2014. Multivariable regression models are used to assess the relationship between length of stay, mortality, and 30-day unplanned readmission and the presence of a clinically validated PSI. Cases flagged with a clinically validated PSI are associated with a statistically greater length of stay, 30-day unplanned readmission, and mortality as compared to cases without a PSI. This study demonstrates a strong association between clinically validated PSIs and patient outcomes. The findings have important implications in policy and practice as health care reform dictates improvement in the experience of care, health of populations, and per capita costs.

Agency for Healthcare Research and Quality Patient Safety Indicators and Mortality in Surgical Patients

2014 ◽  
Vol 80 (8) ◽  
pp. 801-804 ◽  
Author(s):  
Rajesh Ramanathan ◽  
Patricia Leavell ◽  
Luke G. Wolfe ◽  
Therese M. Duane
Keyword(s):  
Patient Safety ◽  
Length Of Stay ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Length ◽  
Healthcare Research ◽  
Hospital Length Of Stay ◽  
Surgical Patients ◽  
Patient Safety Indicators ◽  
Academic Medical

Patient safety indicators (PSI), developed by the Agency for Healthcare Research and Quality, use administrative billing data to measure and compare patient safety events at medical centers. We retrospectively examined whether PSIs accurately reflect patients’ risk of mortality, hospital length of stay, and intensive care unit (ICU) requirements at an academic medical center. Surgical patient records with PSIs were reviewed between October 2011 and September 2012 at our urban academic medical center. Primary outcomes studied included mortality, hospital length of stay, and ICU requirements. Subset analysis was performed for each PSI and its association with the outcome measures. PSIs were more common among surgical patients who died as compared with those alive at discharge (35.3 vs 2.7 PSIs/100 patients, P < 0.01). Although patients who died with PSIs had shorter hospital courses, they had a significantly greater ICU requirement than those without a PSI (96.0 vs 61.1%, P < 0.01) and patients who were alive at discharge (96.0 vs 48.0%, P < 0.01). The most frequently associated PSIs with mortality were postoperative metabolic derangements (41.7%), postoperative sepsis (38.5%), and pressure ulcers (33.3%). PSIs occur at a higher frequency in surgical patients who die and are associated with increased ICU requirements.

scholarly journals Navigating a ship with a broken compass: evaluating standard algorithms to measure patient safety

2016 ◽  
Vol 24 (2) ◽  
pp. 310-315 ◽  
Author(s):  
Jennifer L Hefner ◽  
Timothy R Huerta ◽  
Ann Scheck McAlearney ◽  
Barbara Barash ◽  
Tina Latimer ◽  
...  
Keyword(s):  
Patient Safety ◽  
Administrative Data ◽  
Medical Center ◽  
Academic Medical Center ◽  
Vascular Tumor ◽  
Healthcare Research ◽  
Fiscal Year ◽  
Research Attention ◽  
Patient Safety Indicators ◽  
Hospital Administrative

Objective: Agency for Healthcare Research and Quality (AHRQ) software applies standardized algorithms to hospital administrative data to identify patient safety indicators (PSIs). The objective of this study was to assess the validity of PSI flags and report reasons for invalid flagging. Material and Methods: At a 6-hospital academic medical center, a retrospective analysis was conducted of all PSIs flagged in fiscal year 2014. A multidisciplinary PSI Quality Team reviewed each flagged PSI based on quarterly reports. The positive predictive value (PPV, the percent of clinically validated cases) was calculated for 12 PSI categories. The documentation for each reversed case was reviewed to determine the reasons for PSI reversal. Results: Of 657 PSI flags, 185 were reversed. Seven PSI categories had a PPV below 75%. Four broad categories of reasons for reversal were AHRQ algorithm limitations (38%), coding misinterpretations (45%), present upon admission (10%), and documentation insufficiency (7%). AHRQ algorithm limitations included 2 subcategories: an “incident” was inherent to the procedure, or highly likely (eg, vascular tumor bleed), or an “incident” was nonsignificant, easily controlled, and/or no intervention was needed. Discussion: These findings support previous research highlighting administrative data problems. Additionally, AHRQ algorithm limitations was an emergent category not considered in previous research. Herein we present potential solutions to address these issues. Conclusions: If, despite poor validity, US policy continues to rely on PSIs for incentive and penalty programs, improvements are needed in the quality of administrative data and the standardized PSI algorithms. These solutions require national motivation, research attention, and dissemination support.

Validity of Agency for Healthcare Research and Quality Patient Safety Indicators at an Academic Medical Center

2013 ◽  
Vol 79 (6) ◽  
pp. 578-582 ◽  
Author(s):  
Rajesh Ramanathan ◽  
Patricia Leavell ◽  
Gregory Stockslager ◽  
Catherine Mays ◽  
Dale Harvey ◽  
...  
Keyword(s):  
Patient Safety ◽  
Pay For Performance ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bloodstream Infections ◽  
Healthcare Research ◽  
Contributing Factors ◽  
Current Form ◽  
Patient Safety Indicators ◽  
Academic Medical

The Agency for Healthcare Research and Quality developed Patient Safety Indicators (PSI) to screen for in-hospital complications and patient safety events through International Classification of Diseases, 9th Revision, Clinical Modification coding. The purpose of this study was to validate 10 common surgically related PSIs at our academic medical center and investigate the causes for inaccuracies. We reviewed patient records between October 2011 and September 2012 at our urban academic medical center for 10 common surgically related PSIs. The records were reviewed for incorrectly identified PSIs and a subset was further reviewed for the contributing factors. There were 93,169 charts analyzed for PSIs and 358 PSIs were identified (3.84 per 1000 cases). The overall positive predictive value (PPV) was 83 per cent (95% confidence interval 79 to -86%). The lowest PPVs were associated with catheter-related bloodstream infections (67%), postoperative respiratory failure (71%), and pressure ulcers (79%). The most common contributing factors for incorrect PSIs were coding errors (30%), documentation errors (19%), and insufficient criteria for PSI in the chart (16%). We conclude that the validity of PSIs is low and could be improved by increased education for clinicians and coders. In their current form, PSIs remain suboptimal for widespread use in public reporting and pay-for-performance evaluation.

scholarly journals Impact of Inactive Empiric Antimicrobial Therapy on Inpatient Mortality and Length of Stay

2006 ◽  
Vol 50 (10) ◽  
pp. 3355-3360 ◽  
Author(s):  
Kimberly K. Scarsi ◽  
Joe M. Feinglass ◽  
Marc H. Scheetz ◽  
Michael J. Postelnick ◽  
Maureen K. Bolon ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antimicrobial Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bloodstream Infections ◽  
Empiric Therapy ◽  
Inpatient Mortality ◽  
In Vitro Susceptibility ◽  
Empiric Antimicrobial Therapy

ABSTRACT The consequences of inactive empiric antimicrobial therapy are not well-described and may cause prolonged hospitalization or infection-related mortality. In vitro susceptibility results for 884 patients hospitalized at an academic medical center with gram-negative bloodstream infections (GNBI) from 2001 to 2003 were matched to antimicrobial orders within 24 h of culture. Clinical characteristics, organism, inpatient mortality, and length of stay after culture for patients with GNBI were compared between patients receiving active versus inactive empiric antimicrobial therapy. A total of 14.1% of patients with GNBI received inactive empiric therapy, defined as no antimicrobial therapy within 24 h of the culture active against the identified organism based on in vitro microbiology reports. Patients who received inactive therapy were more likely to be younger, to be infected with Pseudomonas aeruginosa, to have a nosocomial infection, and to receive antimicrobial monotherapy but less likely to be bacteremic with Escherichia coli or to have sepsis (P < 0.05). There were no significant differences in mortality between patients receiving active versus inactive empiric therapy (16.1% versus 13.6%, respectively) or in length of stay after positive culture (11.5 days versus 12.6 days, respectively). Only 45 patients had greater than 2 days of exposure to inactive therapy; however, 8/30 patients (26.7%) who never received active antimicrobial therapy died while in the hospital. Inactive empiric therapy was more common in healthier patients. Inactive antimicrobial therapy in the first 24 h did not significantly impact average outcomes for GNBI among hospitalized patients but may have caused harm to specific individuals.

scholarly journals Many Neurology Readmissions Are Nonpreventable

2016 ◽  
Vol 7 (2) ◽  
pp. 61-69 ◽  
Author(s):  
Sidney T. Le ◽  
S. Andrew Josephson ◽  
Hans A. Puttgen ◽  
Lorrie Gibson ◽  
Elan L. Guterman ◽  
...  
Keyword(s):  
Length Of Stay ◽  
San Francisco ◽  
Chart Review ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Johns Hopkins Hospital ◽  
Unplanned Readmission ◽  
Neurosurgical Procedures ◽  
Patient Age ◽  
Patient Âgé

Introduction: Reducing unplanned hospital readmissions has become a national focus due to the Centers for Medicare and Medicaid Services’ (CMS) penalties for hospitals with high rates. A first step in reducing unplanned readmission is to understand which patients are at high risk for readmission, which readmissions are planned, and how well planned readmissions are currently captured in comparison to patient-level chart review. Methods: We examined all 5455 inpatient neurology admissions over a 2-year period to University of California San Francisco Medical Center and Johns Hopkins Hospital via chart review. We collected information such as patient age, procedure codes, diagnosis codes, all-payer diagnosis-related group, observed length of stay (oLOS), and expected length of stay. We performed multivariate logistic modeling to determine predictors of readmission. Discharge summaries were reviewed for evidence that a subsequent readmission was planned. Results: A total of 353 (6.5%) discharges were readmitted within 30 days. Fifty-five (15.6%) of the 353 readmissions were planned, most often for a neurosurgical procedure (41.8%) or immunotherapy (23.6%). Only 8 of these readmissions would have been classified as planned using current CMS methodology. Patient age (odds ratio [OR] = 1.01 for each 10-year increase, P < .001) and estimated length of stay (OR = 1.04, P = .002) were associated with a greater likelihood of readmission, whereas index admission oLOS was not. Conclusions: Many neurologic readmissions are planned; however, these are often classified by current CMS methodology as unplanned and penalized accordingly. Modifications of the CMS lists for potentially planned neurological and neurosurgical procedures and for acute discharge neurologic diagnoses should be considered.

scholarly journals Family Medicine Patients Have Shorter Length of Stay When Cared for on a Family Medicine Inpatient Service

2019 ◽  
Vol 10 ◽  
pp. 215013271984051 ◽  
Author(s):  
Gregory M. Garrison ◽  
Rachel L. Keuseman ◽  
Christopher L. Boswell ◽  
Jennifer L. Horn ◽  
Nathaniel T. Nielsen ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Length Of Stay ◽  
Medical Center ◽  
Academic Medical Center ◽  
General Medicine ◽  
Inpatient Service ◽  
Academic Medical ◽  
The Family ◽  
Hospital To Home

Introduction: Hospitalists have been shown to have shorter lengths of stays than physicians with concurrent outpatient practices. However, hospitalists at academic medical centers may be less aware of local resources that can support the hospital to home transition for local primary care patients. We hypothesized that local family medicine patients admitted to a family medicine inpatient service have shorter length of stay than those admitted to general hospitalist services which also care for tertiary patients at an academic medical center. Methods: A retrospective cohort study was conducted at an academic medical center with a department of family medicine providing primary care to over 80 000 local patients. A total of 3100 consecutive family medicine patients admitted to either the family medicine inpatient service or a general medicine inpatient service over 3 years were studied. The primary outcome was length of stay, which was adjusted using multivariate linear regression for demographics, prior utilization, diagnosis, and disease severity. Results: Adjusted length of stay was 33% longer (95% CI 24%-44%) for local family medicine patients admitted to general medicine inpatient services as compared with the family medicine inpatient service. Readmission rates within 30 days were not different (19% vs 16%, P = .14). Conclusions: Local primary care patients were safely discharged from the hospital sooner on the family medicine inpatient service than on general medicine inpatient services. This is likely because the family physicians staffing their inpatient service are more familiar with outpatient resources that can be effectively marshaled to help local patients with the transition from hospital to home.

Patient Safety Trilogy: Perspectives from Clinical Engineering

2013 ◽  
Vol 47 (2) ◽  
pp. 137-142 ◽  
Author(s):  
Izabella Gieras ◽  
Paul Sherman ◽  
Dennis Minsent
Keyword(s):  
Patient Safety ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Engineering ◽  
Veterans Health ◽  
Health Administration ◽  
Healthcare Technology ◽  
Academic Medical ◽  
Clinical Engineers

This article examines the role a clinical engineering or healthcare technology management (HTM) department can play in promoting patient safety from three different perspectives: a community hospital, a national government health system, and an academic medical center. After a general overview, Izabella Gieras from Huntington Hospital in Pasadena, CA, leads off by examining the growing role of human factors in healthcare technology, and describing how her facility uses clinical simulations in medical equipment evaluations. A section by Paul Sherman follows, examining patient safety initiatives from the perspective of the Veterans Health Administration with a focus on hazard alerts and recalls. Dennis Minsent from Oregon Health & Science University writes about patient safety from an academic healthcare perspective, and details how clinical engineers can engage in multidisciplinary safety opportunities.

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