Prevalence of patient safety indicators and hospital-acquired conditions in those treated for unruptured cerebral aneurysms: establishing standard performance measures using the Nationwide Inpatient Sample database

2013 ◽  
Vol 119 (4) ◽  
pp. 966-973 ◽  
Author(s):  
Kyle M. Fargen ◽  
Maryam Rahman ◽  
Dan Neal ◽  
Brian L. Hoh
Keyword(s):  
Health Care ◽  
Adverse Event ◽  
Patient Safety ◽  
Nationwide Inpatient Sample ◽  
Cerebral Aneurysms ◽  
Patient Safety Indicators ◽  
Hospital Acquired Conditions ◽  
Unruptured Cerebral Aneurysms ◽  
Hospital Acquired

Object The Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are metrics used to gauge the quality of health care provided by health care institutions. The PSIs and HACs are publicly reported metrics and are directly linked to reimbursement for services. To better understand the prevalence of these adverse events in hospitalized patients treated for unruptured cerebral aneurysms, the authors determined the incidence rates of PSIs and HACs among patients with a diagnosis of unruptured aneurysm in the Nationwide Inpatient Sample (NIS) database. Methods The NIS, part of the AHRQ's Healthcare Cost and Utilization Project, was queried for all hospitalizations between 2002 and 2010 involving coiling or clipping of unruptured cerebral aneurysms. The incidence rate for each PSI and HAC was determined by searching the hospital records for ICD-9 codes. The SAS statistical software package was used to calculate incidences and perform multivariate analyses to determine the effects of patient variables on the probability of each indicator developing. Results There were 54,589 hospitalizations involving unruptured cerebral aneurysms in the NIS database for the years 2002–2010; 8314 patients (15.2%) underwent surgical clipping and 9916 (18.2%) were treated with endovascular coiling. One thousand four hundred ninety-two PSI and HAC events occurred among the 8314 patients treated with clipping; at least 1 PSI or HAC occurred in 14.6% of these patients. There were 1353 PSI and HAC events among the 9916 patients treated with coiling; at least 1 PSI or HAC occurred in 10.9% of these patients. Age, sex, and comorbidities had statistically significant associations with an adverse event. Compared with the patients having no adverse event, those having at least 1 PSI during their hospitalizations had significantly longer hospital stays (p < 0.0001), higher hospital costs (p < 0.0001), and higher mortality rates (p < 0.0001). Conclusions These results estimate baseline national rates of PSIs and HACs in patients with unruptured cerebral aneurysms. These data may be used to gauge individual institutional quality of care and patient safety metrics in comparison with national data.

The prevalence of patient safety indicators and hospital-acquired conditions in patients with ruptured cerebral aneurysms: establishing standard performance measures using the Nationwide Inpatient Sample database

2013 ◽  
Vol 119 (6) ◽  
pp. 1633-1640 ◽  
Author(s):  
Kyle M. Fargen ◽  
Dan Neal ◽  
Maryam Rahman ◽  
Brian L. Hoh
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Nationwide Inpatient Sample ◽  
Cerebral Aneurysms ◽  
Incidence Rates ◽  
Patient Safety Indicators ◽  
Nationwide Inpatient Sample Database ◽  
Hospital Acquired Conditions ◽  
Hospital Acquired

Object The Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are publicly reported metrics used to gauge the quality of health care provided by health care institutions. To better understand the prevalence of these events in hospitalized patients treated for ruptured cerebral aneurysms, the authors determined the incidence rates of PSIs and HACs among patients with a diagnosis of subarachnoid hemorrhage and procedure codes for either coiling or clipping in the Nationwide Inpatient Sample database. Methods The authors queried the Nationwide Inpatient Sample database, part of the AHRQ's Healthcare Cost and Utilization Project, for all hospitalizations between 2002 and 2010 involving coiling or clipping of ruptured cerebral aneurysms. The incidence rate of each PSI and HAC was determined by searching the hospital records for ICD-9 codes. The authors used the SAS statistical software package to calculate incidence rates and perform multivariate analyses to determine the effects of patient variables on the probability of developing each indicator. Results There were 62,972 patient admissions with a diagnosis code of subarachnoid hemorrhage between the years 2002 and 2010; 10,274 (16.3%) underwent clipping and 8248 (13.1%) underwent endovascular coiling. A total of 6547 PSI and HAC events occurred within the 10,274 patients treated with clipping; at least 1 PSI or HAC occurred in 47.9% of these patients. There were 5623 total PSI and HAC events among the 8248 patients treated with coils; at least 1 PSI or HAC occurred in 51.0% of coil-treated patients. Age, sex, comorbidities, hospital size, and hospital type had statistically significant associations with indicator occurrence. Compared with patients without events, those treated by either clipping or coiling and had at least 1 PSI during their hospitalization had significantly longer lengths of stay (p < 0.001), higher hospital costs (p < 0.001), and higher in-hospital mortality rates (p < 0.001). Conclusions These results estimate baseline national rates of PSIs and HACs in patients treated for ruptured cerebral aneurysms. These data may be used to gauge individual institutional quality of care and patient safety metrics in comparison with national data.

Comparing the coding of complications in Queensland and Victorian admitted patient data

2011 ◽  
Vol 35 (3) ◽  
pp. 245 ◽  
Author(s):  
Jude L. Michel ◽  
Diana Cheng ◽  
Terri J. Jackson
Keyword(s):  
Patient Safety ◽  
Data Quality ◽  
Secondary Analysis ◽  
Routine Data ◽  
Complication Rates ◽  
Hospital Data ◽  
Patient Safety Indicators ◽  
Hospital Acquired Conditions ◽  
Hospital Acquired

Objective. To examine differences between Queensland and Victorian coding of hospital-acquired conditions and suggest ways to improve the usefulness of these data in the monitoring of patient safety events. Design. Secondary analysis of admitted patient episode data collected in Queensland and Victoria. Methods. Comparison of depth of coding, and patterns in the coding of ten commonly coded complications of five elective procedures. Results. Comparison of the mean complication codes assigned per episode revealed Victoria assigns more valid codes than Queensland for all procedures, with the difference between the states being significantly different in all cases. The proportion of the codes flagged as complications was consistently lower for Queensland when comparing 10 common complications for each of the five selected elective procedures. The estimated complication rates for the five procedures showed Victoria to have an apparently higher complication rate than Queensland for 35 of the 50 complications examined. Conclusion. Our findings demonstrate that the coding of complications is more comprehensive in Victoria than in Queensland. It is known that inconsistencies exist between states in routine hospital data quality. Comparative use of patient safety indicators should be viewed with caution until standards are improved across Australia. More exploration of data quality issues is needed to identify areas for improvement. What is known about the topic? Routine data are low cost, accessible and timely but the quality is often questioned. This deters researchers and clinicians from using the data to monitor aspects of quality improvement. Previous studies have reported on the quality of diagnosis coding in Australia but not specifically on the quality of use of the condition-onset flag denoting hospital-acquired conditions. What does this paper add? Few studies have tested the consistency of the data between Australian states. No previous studies have evaluated the comprehensiveness of the coding of hospital-acquired conditions using routine data. This paper compares two states to highlight the differences in the coding of complications, with the aim of improving routine data to support patient safety. What are the implications for practitioners? The results imply more work needs to be done to improve the coding and flagging of complications so the data are valid and comprehensive. Further research should identify problem areas responsible for differences in the data so that training and audit strategies can be developed to improve the collection of this information. Practitioners may then be more confident in using routine coded inpatient data as part of the process of monitoring patient safety.

scholarly journals Relationship between patient safety indicator events and comprehensive stroke center volume status in the treatment of unruptured cerebral aneurysms

2018 ◽  
Vol 129 (2) ◽  
pp. 471-479 ◽  
Author(s):  
Chad W. Washington ◽  
L. Ian Taylor ◽  
Robert J. Dambrino ◽  
Paul R. Clark ◽  
Gregory J. Zipfel
Keyword(s):  
Patient Safety ◽  
Cerebral Aneurysm ◽  
Cerebral Aneurysms ◽  
Volume Status ◽  
Patient Safety Indicators ◽  
Poor Outcome ◽  
Unruptured Cerebral Aneurysm ◽  
Unruptured Cerebral Aneurysms ◽  
Comprehensive Stroke Center ◽  
Stroke Center

OBJECTIVEThe Agency of Healthcare Research and Quality (AHRQ) has defined Patient Safety Indicators (PSIs) for assessments in quality of inpatient care. The hypothesis of this study is that, in the treatment of unruptured cerebral aneurysms (UCAs), PSI events are less likely to occur in hospitals meeting the volume thresholds defined by The Joint Commission for Comprehensive Stroke Center (CSC) certification.METHODSUsing the 2002–2011 National (Nationwide) Inpatient Sample, patients treated electively for a nonruptured cerebral aneurysm were selected. Patients were evaluated for PSI events (e.g., pressure ulcers, retained surgical item, perioperative hemorrhage, pulmonary embolism, sepsis) defined by AHRQ-specified ICD-9 codes. Hospitals were categorized by treatment volume into CSC or non-CSC volume status based on The Joint Commission’s annual volume thresholds of at least 20 patients with subarachnoid hemorrhage and performance of 15 or more endovascular coiling or surgical clipping procedures for aneurysms.RESULTSA total of 65,824 patients underwent treatment for an unruptured cerebral aneurysm. There were 4818 patients (7.3%) in whom at least 1 PSI event occurred. The overall inpatient mortality rate was 0.7%. In patients with a PSI event, this rate increased to 7% compared with 0.2% in patients without a PSI event (p < 0.0001). The overall rate of poor outcome was 3.8%. In patients with a PSI event, this rate increased to 23.3% compared with 2.3% in patients without a PSI event (p < 0.0001). There were significant differences in PSI event, poor outcome, and mortality rates between non-CSC and CSC volume-status hospitals (PSI event, 8.4% vs 7.2%; poor outcome, 5.1% vs 3.6%; and mortality, 1% vs 0.6%). In multivariate analysis, all patients treated at a non-CSC volume-status hospital were more likely to suffer a PSI event with an OR of 1.2 (1.1–1.3). In patients who underwent surgery, this relationship was more substantial, with an OR of 1.4 (1.2–1.6). The relationship was not significant in the endovascularly treated patients.CONCLUSIONSIn the treatment of unruptured cerebral aneurysms, PSI events occur relatively frequently and are associated with significant increases in morbidity and mortality. In patients treated at institutions achieving the volume thresholds for CSC certification, the likelihood of having a PSI event, and therefore the likelihood of poor outcome and mortality, was significantly decreased. These improvements are being driven by the improved outcomes in surgical patients, whereas outcomes and mortality in patients treated endovascularly were not sensitive to the CSC volume status of the hospital and showed no significant relationship with treatment volumes.

scholarly journals Health disparities and stroke: the influence of insurance status on the prevalence of patient safety indicators and hospital-acquired conditions

2015 ◽  
Vol 122 (4) ◽  
pp. 870-875 ◽  
Author(s):  
Kyle M. Fargen ◽  
Dan Neal ◽  
Spiros L. Blackburn ◽  
Brian L. Hoh ◽  
Maryam Rahman
Keyword(s):  
Patient Safety ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Private Insurance ◽  
Multivariable Analysis ◽  
Healthcare Research ◽  
Insurance Status ◽  
Patient Safety Indicators ◽  
Hospital Acquired Conditions ◽  
Hospital Acquired

OBJECT The Agency for Healthcare Research and Quality patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are publicly reported quality metrics linked directly to reimbursement. The occurrence of PSIs and HACs is associated with increased mortality and hospital costs after stroke. The relationship between insurance status and PSI and HAC rates in hospitalized patients treated for acute ischemic stroke was determined using the Nationwide Inpatient Sample (NIS) database. METHODS The NIS was queried for all hospitalizations involving acute ischemic stroke between 2002 and 2011. The rate of each PSI and HAC was determined by searching the hospital records for ICD-9 codes. The SAS statistical software package was used to calculate rates and perform multivariable analyses to determine the effects of patient variables on the probability of developing each indicator. RESULTS The NIS query revealed 1,507,336 separate patient admissions that had information on both primary payer and hospital teaching status. There were 227,676 PSIs (15.1% of admissions) and 42,841 HACs reported (2.8%). Patient safety indicators occurred more frequently in Medicaid/self-pay/no-charge patients (19.1%) and Medicare patients (15.0%) than in those with private insurance (13.6%; p < 0.0001). In a multivariable analysis, Medicaid, self-pay, or nocharge patients had significantly longer hospital stays, higher mortality, and worse outcomes than those with private insurance (p < 0.0001). CONCLUSIONS Insurance status is an independent predictor of patient safety events after stroke. Private insurance is associated with lower mortality, shorter lengths of stay, and improved clinical outcomes.

Hospital-Acquired Infections as Patient Safety Indicators

2006 ◽  
Vol 24 (1) ◽  
pp. 75-99 ◽  
Author(s):  
Ann Marie B. Peterson ◽  
Patricia H. Walker
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Hospital Epidemiology ◽  
Patient Safety Indicators ◽  
Hospital Acquired Infections ◽  
Organizational Issues ◽  
Care Workers ◽  
Increased Risk ◽  
Care Worker ◽  
Hospital Acquired

Transmission of infection in the hospital has been identified as a patient safety problem adversely affecting patients, visitors, and health care workers. Prevention of infection should not be limited to the hospital epidemiology staff but also must involve the entire multidisciplinary team, including nurses. This chapter reviews the literature related to patient safety of nursing-authored studies of infection control in the hospital. The review indicated that there were key areas of research interest including drug resistance; hand hygiene products, procedures, and surveillance; preoperative skin preparations; health care worker transmission of infection; common procedures associated with an increased risk of transmission; and organizational issues.

scholarly journals Enhancing description of hospital-conditions with ICD-11 cluster coding: Better codes for monitoring and prevention

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Danielle Southern ◽  
Catherine Eastwood ◽  
Hude Quan ◽  
William Ghali
Keyword(s):  
Health Care ◽  
Information Systems ◽  
Conceptual Model ◽  
Hospital Acquired Conditions ◽  
Incorrect Diagnosis ◽  
Clinical Detail ◽  
Administrative Information ◽  
Hospital Acquired ◽  
Related Harm

IntroductionExposure to health care events sometimes has unintended and undesired consequences. Health care and complications arising in the course of care are diverse and complex. Representing them comprehensively in information systems is challenging, and presently beyond the bounds of practicality for routine administrative information systems that include ICD coded data. Objectives and ApproachThe ICD-11 conceptual model for hospital-acquired conditions has 3 components: 1) harm to patient 2) cause or source of harm and 3) mode or mechanism. A key feature of the Quality and Safety (Q\&S) code-set in ICD-11 is that a cluster of codes is required to represent an event or injury. Use of the term ‘cluster’ is novel in ICD-11 and so is the extent and the requirement for post-coordination. The cluster required to code a Q\&S case has three codes, one for each of the three components of the model given above. ResultsThe first component, ‘harm’, is represented by an ICD–11 diagnosis code, from any chapter of the classification. Q\&S causes or sources of harm fall into 4 types that capture events caused by substances (drugs and medicaments, etc.), procedures, devices, and a mix of other types of causes (e.g. problems associated with transfusions, incorrect diagnosis, etc.). Q\&S ‘mode or mechanism’ refers to the main way in which the ‘cause’ leads to the ‘harm’ and are specific to the type of ‘cause’ (Table 1). Table 1 - Examples of corresponding Q\&S Mode or Mechanism Cause or Source of Harm Mode or Mechanism Substance Overdose, under-dose, wrong substance. Procedure Accidental perforation of an organ during a procedure. Device Dislodgement. Malfunction. Other cause Mismatched blood. Patient dropped during transfer from OR table. Conclusion/ImplicationsThis new conceptual model for coding healthcare-related harm, dependent on the clustering of codes, has great potential to improve the clinical detail of adverse event descriptions, and the overall quality of coded health data, for better monitoring and strategies for prevention.

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