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Toolkit for Using the AHRQ Quality Indicators
How To Improve Hospital Quality and Safety
Fact Sheet on Patient Safety Indicators

What Are the Patient Safety Indicators?
The Patient Safety Indicators (PSIs) are a set of 26 indicators (including 18 provider-level
indicators) developed by the Agency for Healthcare Research and Quality (AHRQ) to provide
information on safety-related adverse events occurring in hospitals following operations,
procedures, and childbirth. The PSIs were developed after a comprehensive literature review,
analysis of available ICD-9-CM 1 codes, review by a clinician panel, implementation of risk
adjustment, and empirical analyses.
The PSIs use administrative data in the typical hospitalization discharge record to identify potential
in-hospital complications. The provider-level indicators can be used to help hospitals identify
adverse events worthy of further study and to assess the incidence of such events for comparative
purposes. Some of these indicators also have area-level analogs designed to detect patient safety
events on a county or regional level.
PSI 90 is a composite measure that is intended to reflect the safety climate of the hospital by
providing a marker of patient safety (or “avoidance of harm”) during the delivery of health care. As
a single and transparent metric, it can be easily used to monitor performance over time or across
regions and populations using a methodology that can be applied at the national, regional, State,
and provider level. Each PSI in the the PSI 90 composite is amenable to prevention through
system-level related structures and processes of care.
The PSI 90 composite indicator is intended to be used primarily to monitor performance in national
and regional reporting, and also for comparative reporting and quality improvement at the provider
level. It is not intended to reflect any broader construct of quality, beyond what is reflected in the
component indicators themselves. Use of a composite can assist consumers in selecting hospitals,
assist clinicians in allocating resources, and assist payers in assessing performance; especially in
the presence of competing priorities or where than more than one component measure may be
important.
A Snapshot of the Indicators

The current provider-level PSIs are listed in Table 1, along with information on their 2012 annual
rates and status regarding NQF endorsement.
A detailed list of indicator specifications, software for calculating the measures, and software
documentation are available on the AHRQ Quality Indicators Web
site: www.qualityindicators.ahrq.gov.
1
ICD-9 = International Classification of Diseases, 9th Revision.
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Table 1. The 2015 AHRQ Provider-Level Patient Safety Indicators (PSIs), With 2012 Rates and
National Quality Forum Endorsement Status
NQF Endorsement
Observed Most
Area-Level Rate per Recent
Patient Safety Indicator Indicator 1,000 NQF Nbr Year
PSI 02 Death Rate in Low-Mortality Diagnosis- 0.32 0347 2012
Related Groups (DRGs)
PSI 03 Pressure Ulcer Rate 0.50
PSI 04 Death Rate Among Surgical Inpatients with 118.62 0351 2012
Serious Treatable Complications
PSI 05 Retained Surgical Item or Unretrieved X N/A* 0363 2012
Device Fragment Count
PSI 06 Iatrogenic Pneumothorax Rate X 0.34 0346 2012
PSI 07 Central Venous Catheter-related X 0.21
Bloodstream Infection Rate
PSI 08 Postoperative Hip Fracture Rate 0.04
PSI 09 Perioperative Hemorrhage or Hematoma X 5.11
Rate
PSI 10 Postoperative Physiologic and Metabolic 0.69
Derangement Rate
PSI 11 Postoperative Respiratory Failure Rate 10.05 0533 2009
PSI 12 Perioperative Pulmonary Embolism or 4.99 0450 2012
Deep Vein Thrombosis Rate
PSI 13 Postoperative Sepsis Rate 9.61
PSI 14 Postoperative Wound Dehiscence Rate X 1.86
PSI 15 Accidental Puncture or Laceration Rate X 1.89 0345 2012
PSI 16 Transfusion Reaction Count X N/A* 0349 2012
PSI 17 Birth Trauma Rate – Injury to Neonate 1.89
PSI 18 Obstetric Trauma Rate – vaginal delivery 133.19
with instrument
PSI 19 Obstetric Trauma Rate – vaginal delivery 20.97
without instrument
PSI 90 Patient Safety for Selected Indicators ** 0531 2015
*N/A: Not applicable, measure is based on a count of events.
** Composite measure
Based on AHRQ QI software version 5.0 for ICD-9, as of March 2015; 2012 is the most recent version of HCUP
available at time of toolkit publication.
Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project (HCUP) State
Inpatient Databases (SID), 2012; AHRQ Quality Indicators Patient Safety Indicators Benchmark Data
Tables. http://www.qualityindicators.ahrq.gov/Modules/psi_resources.aspx.
AHRQ Quality Indicators Software

AHRQ provides free software—in both SAS® and Windows—for organizations to apply the PSIs
to their own data to assist quality improvement efforts in acute care hospital settings. Both versions
of the software include all the AHRQ QI modules, including the PSIs.
Many of the PSIs are calculated using present on admission (POA) codes in the hospital discharge
data. In QI software version 5.0, the user had the option of indicating that POA should not be
2 Tool A.1b
considered when running the software. In version 6.0, the option to ignore POA was removed. It is
now assumed that all data include valid POA information.
In October 2015, the International Classification of Diseases, Ninth Revision, Clinical

Modification (ICD-9-CM) used to report medical diagnoses and inpatient procedures was officially
replaced by the International Classification of Diseases, Tenth Revision, Clinical Modification
(ICD-10-CM). This transition affected diagnosis and inpatient procedure coding across the United
States. As of spring 2016, AHRQ has updated the QI software (v6.0) to account for the change to
ICD-10. Because hospitals have just begun coding with ICD-10 codes, there are no available
national data that allow hospitals to compare their measures to national benchmarks; however,
future versions of the software will calculate risk-adjusted measures.
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Toolkit for Using the AHRQ Quality Indicators

How To Improve Hospital Quality and Safety

Fact Sheet on Patient Safety Indicators

A Snapshot of the Indicators

AHRQ Quality Indicators Software

In October 2015, the International Classification of Diseases, Ninth Revision, Clinical

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