Despite the fact that the Agency for Healthcare Research and Quality patient safety indicators (PSIs) are useful for evaluating adverse events in hospitals, the 20 PSIs make it difficult to summarize broad trends across indicators. This study aims to identify 1 or more measures among the PSIs best suited for a quick index of general patient safety status. The 1997-2002 Nationwide Inpatient Sample was used to calculate the hospital-level risk-adjusted rates of the PSIs. Both pairwise correlation analyses and multivariate analyses showed that PSI #7 (Selected infections due to medical care) is significantly correlated with most of the other PSIs. The results are robust even when (1) the pairwise and multivariate analyses are rerun on a reduced data set that excludes admissions with multiple patient safety events, and (2) Bonferroni-adjusted P values are calculated. The study concludes that PSI #7 appears to be a candidate for a quick index of patient safety status. (Am J Med Qual 2009;24:465-473)
Leape LLError in medicine. JAMA. 1994;272:1851-1857.
2.
Institute of Medicine.To Err is Human: Building a Safer Healthcare System. Washington, DC: Institute of Medicine; 2000.
3.
Institute of Medicine.Patient Safety: Achieving a New Standard of Care. Washington, DC: Institute of Medicine; 2004.
4.
McDonald KM, Romano PS, Geppert JJ, et al. Measures of Patient Safety Based on Hospital Administrative Data: The Patient Safety Indicators. Rockville, MD: Association for Healthcare Research and Quality;2002.
5.
Coffey RM, Andrews RM, Moy E.Racial, ethnic, and socio-economic disparities in estimates of AHRQ patient safety indicators. Med Care. 2005;43(3 suppl):148-157.
6.
Zhan C., Miller MR, Wong H., Meyer GSThe effects of HMO penetration on preventable hospitalizations. Health Serv Res. 2004;39:345-361.
7.
Miller MR, Elixhauser A., Zhan C.Patient safety events during pediatric hospitalizations. Pediatrics. 2003;111(6, pt 1):1358-1366.
8.
Miller MR, Zhan C.Pediatric patient safety in hospitals: a national picture in2000. Pediatrics. 2004;113:1741-1746.
9.
Romano PS, Geppert JJ, Davies S., Miller MR, Elixhauser A., McDonald KMA national profile of patient safety in U.S. hospitals. Health Aff (Millwood). 2003;22:154-166.
10.
Slonim AD, LaFleur BJ, Ahmed W., Joseph JGHospital-reported medical errors in children. Pediatrics . 2003;111: 617-621.
11.
Zhan C., Miller MRExcess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA. 2003 ;290:1868-1874.
12.
Rosen AK, Rivard P., Zhao S., et al. Evaluating the patient safety indicators: how well do they perform on Veterans Health Administration data? Med Care. 2005;43:873-884.
13.
Fiscella K. , Franks P., Meldrum S., Barnett S.Racial disparity in surgical complications in New York State. Ann Surg. 2005;242:151-155.
14.
Shufelt JL, Hannan EL, Gallagher BKThe postoperative hemorrhage and hematoma patient safety indicator and its risk factors. Am J Med Qual. 2005;20:210-218.
15.
Poulose BK, Ray WA, Arbogast PG, et al. Resident work hour limits and patient safety. Ann Surg.2005;241:847-856; discussion 856-860.
16.
Sedman A., Harris JM II, Schulz K., et al. Relevance of the Agency for Healthcare Research and Quality patient safety indicators for children’s hospitals. Pediatrics.2005;115: 135-145.
17.
Weller WE, Gallagher BK, Cen L., Hannan ELReadmissions for venous thromboembolism: expanding the definition of patient safety indicators. Jt Comm J Qual Patient Saf. 2004;30:497-504.
18.
Agency for Healthcare Research and Quality.2005 National Healthcare Quality Report. Rockville, MD: Agency for HealthCare Research and Quality ; 2005.
19.
Klaper R., Thomas MAAt the crossroads of genomics and ecology: the promise of a canary on a chip . Bioscience. 2004;54:403-408.
20.
Dale VH, Beyeler SCChallenges in the development and use of ecological indicators. Ecol Indic. 2001;1:3-10.
21.
Tabor G., Aguirre A.Ecosystem health and sentinel species: adding an ecological element to the proverbial "canary in the mineshaft"EcoHealth. 2004;1:226-228.
22.
Lanphear BPEnvironmental health: the paradox of lead poisoning prevention. Science. 1998;281:1617-1618.
23.
Fleischmann KE, Goldman L., Young B., Lee THAssociation between cardiac and noncardiac complications in patients undergoing noncardiac surgery: outcomes and effects on length of stay. Am J Med. 2003;115:515-520.
24.
Agency for Healthcare Research and Quality.Introduction to the HCUP Nationwide Inpatient Sample (NIS), 2002. Rockville, MD: Agency for Healthcare Research and Quality; 2004.
25.
Agency for Healthcare Research and Quality.AHRQ Quality Indicators-Patient Safety Indicators: Software Documentation, Version 2.1-SAS. Rockville, MD: Agency for Healthcare Research and Quality; 2003.
26.
Agency for Healthcare Research and Quality.AHRQ Quality Indicators-Guide to Patient Safety Indicators, Version 3.1. Rockville, MD: Agency for Healthcare Research and Quality; 2007.
27.
Coste J., Fermanian J., Venot A.Methodological and statistical problems in the construction of composite measurement scales: a survey of six medical and epidemiological journals. Stat Med. 1995;14:331-345.
28.
Nielsen P., Goldman M., Mann S., et al. Effects of teamwork training on adverse outcomes and process of care in labor and delivery: a randomized controlled trial. Obstet Gynecol. 2007;109:48-55.
29.
Agency for Healthcare Research and Quality.AHRQ Quality Indicators-Patient Safety Indicator (PSI) Composite Measure. http://www.qualityindicators.ahrq.gov/news/AHRQ_PSI_Composite_Draft.pdf. Published September 29, 2006. Accessed July 10, 2008.
