How to Assess Quality of Care at Hospitals: Patient Safety Indicators List 2022
How to Assess Quality of Care at Hospitals: Patient Safety Indicators List 2022
The Agency for Healthcare Research and Quality (AHRQ) developed Patient Safety Indicators (PSI) list 2022 to judge the quality of care at hospitals. The data is used:
- By patients to choose where they go for care
- Third party payers to select facilities to contract for services
- Assist QA departments identify potential problem areas
- Help leadership assess. monitor, track, and improve patient safety
- Determine financial gain or loss (CMS PSI 90, contract bonuses for quality)
ICD-10 CM/PCS Coders provide the data used to measure hospital performance against these standards. Furthermore, it behooves Coders to understand these measures and how they are affected by coding.
External coding support and additional coding education could help coders understand how these PSIs are affected by coding. For this reason, contact YES for additional guidance.
History of AHRQ
AHRQ is a part of the U. S. Department of Health and Human Services. Congress created the Agency for Healthcare Policy and Research (AHPR) in 1989 with a ten-year mission to “support research designed to improve quality, safety, efficiency and effectiveness of healthcare for all Americans.” After ten years, the AHPR agency was reauthorized. Additionally, its name changed to Agency for Healthcare Research and Quality (AHRQ). More details can be found at: https://www.allgov.com/.
The AHRQ conducts an annual review of the PSIs to identify global healthcare problems. And ensure relevancy to current quality assurance trends. As a result, PSIs were developed to provide information on safety-related events occurring in hospitals, healthcare facilities, and physician practices. We also provide a detailed overview of the 2023 Final Rule for the Inpatient Prospective Payment System (IPPS) in a previous article here: https://yes-himconsulting.com/review-the-cms-final-rule-2023-for-ipps/. This past summer, the AHRQ retired PSI – 16 Transfusion Reaction Count, which explains gaps in current PSI numbering. Below is a brief description of the 17 active patient safety indicators applicable to hospitals (source: https://www.qualityindicators.ahrq.gov/).
Patient Safety Indicators List 2022
PSI 02 – Death Rate in Low-Mortality Diagnostic Related Groups (DRGs)
In-hospital deaths per 1,000 discharges for low mortality DRGs (patients 18 years and older or obstetric patients). Excludes cases with trauma, cancer, an immunocompromised state, and transfers to an acute care facility.
PSI 03 – Pressure Ulcer Rate
Stage III or IV pressure ulcers or unstageable (secondary diagnosis) per 1,000 discharges (surgical or medical patients 18 years and older). PSI 03 excludes stays less than 3 days; cases with a principal or secondary diagnosis of stage III or IV pressure ulcer or unstageable that is present on admission; obstetric cases; severe burns; exfoliative skin disorders.
PSI 04 – Death Rate among Surgical Inpatients with Serious Treatable Complications
Inpatient deaths per 1,000 surgical discharges (patients 18 through 89 years or obstetric patients) with serious treatable complications (deep vein thrombosis/pulmonary embolism, pneumonia, sepsis, shock/cardiac arrest, or gastrointestinal hemorrhage/acute ulcer). PSI 04 excludes cases transferred to an acute care facility and cases in hospice care at admission.
PSI 05 – Retained Surgical Item or Unretrieved Device Fragment Count
The number of hospital discharges with a retained surgical item or unretrieved device fragment (secondary diagnosis) (surgical and medical patients 18 years and older or obstetric patients). Excludes cases with principal or secondary diagnosis of retained surgical item or unretrieved device fragment present on admission.
*** 1Q 2014 Coding Clinic page 21 – Foreign body intentionally left during surgery where risk of removal exceeds risk of retention is not coded as a complication***
PSI List Continued
PSI 06 – Iatrogenic Pneumothorax Rate
Iatrogenic pneumothorax cases (secondary diagnosis) per 1,000 surgical (medical discharges for patients 18 years and older). Excludes cases with chest trauma, pleural effusion, thoracic surgery, lung or pleural biopsy, diaphragmatic repair, or cardiac procedures; cases with a principal or secondary diagnosis of iatrogenic pneumothorax present on admission; and obstetric cases.
PSI 07 – Central Venous Catheter-Related Blood Stream Infection Rate
Central venous catheter-related bloodstream infections (secondary diagnosis) per 1,000 medical and surgical discharges (patients 18 years and older or obstetric cases). Excludes cases with a principal or secondary diagnosis of a central venous catheter-related bloodstream infection present on admission, stays less than 2 days, cases with an immunocompromised state or cancer.
PSI 08 – In Hospital Fall with Hip Fracture Rate
In hospital fall with hip fracture (secondary diagnosis) per 1,000 discharges (patients 18 years and older).
Excludes discharges with principal diagnosis of a condition with high susceptibility to falls (seizure disorder, syncope, stroke, occlusion of arteries, coma, cardiac arrest, poisoning, trauma, delirium or other psychoses, anoxic brain injury), diagnoses associated with fragile bone (metastatic cancer, lymphoid malignancy, bone malignancy), a principal or secondary diagnosis of hip fracture present on admission, and obstetric cases.
PSI 09 – Perioperative Hemorrhage or Hematoma Rate
Perioperative hemorrhage or hematoma cases involving a procedure to treat the hemorrhage or hematoma following the first surgery per 1,000 surgical discharges (patients 18 years and older). Excludes cases with a diagnosis of coagulation disorder; a principal or secondary diagnosis of perioperative hemorrhage or hematoma present on admission; where the only operating room procedure is for treatment of perioperative hemorrhage or hematoma; obstetric cases.
Postoperative PSIs
PSI 10 – Postoperative Acute Kidney Injury Requiring Dialysis Rate
Postoperative acute kidney failure requiring dialysis per 1,000 elective surgical discharges (patients ages 18 years and older). Excludes cases with principal or secondary diagnosis of acute kidney failure present on admission; secondary diagnosis of acute kidney failure and dialysis procedure before or on the same day as the first operating room procedure; with cardiac arrest, severe cardiac arrhythmia, cardiac shock, chronic kidney failure; a principal diagnosis of urinary tract obstruction, and obstetric cases.
PSI 11 – Postoperative Respiratory Failure Rate
Postoperative respiratory failure (secondary diagnosis), prolonged mechanical ventilation, or reintubation cases per 1,000 elective surgical discharges (patients 18 years and older). Excludes cases with principal or secondary diagnosis of acute respiratory failure present on admission; cases in which tracheostomy is the only operating room procedure or in which tracheostomy occurs before the first operating room procedure; neuromuscular disorders; laryngeal, oropharyngeal or craniofascial surgery involving significant risk of airway compromise; esophageal resection, lung cancer, lung transplant or degenerative neurological disorders; respiratory or circulatory diseases; and obstetric discharges.
PSI 12 – Perioperative Pulmonary Embolism or Deep Vein Thrombosis Rate
Perioperative pulmonary embolism or proximal deep vein thrombosis (secondary diagnosis) per 1,000 surgical discharges (patients 18 years and older). Excludes discharges with a principal or secondary diagnosis of pulmonary embolism or proximal deep vein thrombosis present on admission. In which interruption of the vena cava or a pulmonary arterial thromboembolectomy occurs before or on the same day as the first operating room procedure; with extracorporeal membrane oxygenation; with acute brain or spinal injury present on admission; and obstetric cases.
PSI List Continued
PSI 13 Postoperative Sepsis Rate
Postoperative sepsis cases (secondary diagnosis) per 1,000 elective surgical discharges (patients 18 years and older). Excludes cases with a principal or secondary diagnosis of sepsis present on admission, a principal or secondary diagnosis of infection present on admission, and obstetric cases.
PSI 14 – Postoperative Wound Dehiscence Rate
Postoperative reclosures of the abdomen wall with a diagnosis of disruption of internal operative wound per 1,000 abdominopelvic surgery discharges (patients 18 years and older). Excludes cases in which the abdominal wall reclosure occurs on or before the day of the first abdominopelvic surgery, cases with an immunocompromised state, stays less than two (2) days, and obstetric cases.
PSI 15 – Unrecognized Abdominopelvic Accidental Puncture or Laceration Rate
Accidental punctures or lacerations (secondary diagnosis) per 1,000 discharges (patients 18 years and older) who have undergone a second abdominopelvic procedure which follows one or more days after an index abdominopelvic procedure. Excludes cases with accidental puncture or laceration as a principal or secondary diagnosis that is present on admission. And obstetric cases.
Birth & Obstetric Trauma PSIs
PSI 17 – Birth Trauma Rate – Injury to Neonate
Birth trauma injuries per 1,000 newborns. Excludes preterm infants with a birth weight less than 2,000 grams, and cases with osteogenesis imperfect.
PSI 18 – Obstetric Trauma Rate – Vaginal Delivery with Instrument
Third and fourth degree obstetric traumas per 1,000 instrument-assisted vaginal deliveries.
PSI 19 – Obstetric Trauma Rate – Vaginal Delivery Without Instrument
Third and fourth degree obstetric traumas per 1,000 vaginal deliveries. Excludes cases with instrument-assisted deliveries.
Next Steps
Many hospitals have teams established to monitor PSIs. The effective teams have representatives from Physicians, Nursing, QA, Risk Management, and of course, Coding. Codes from the initial bill pass to this agency. But the corrected codes will not. This is a strong reason why organizations prefer concurrent reviews over retrospective. Active teams can also identify needs for education, training, and even make suggestions to AHQR to improve the PSI hospital system (https://info.ahrq.gov/).
External coding support and additional coding education could help coders understand how these PSIs are affected by coding. Furthermore, contact YES for additional guidance.
