Search results for "Hospitals"

This commentary discusses challenges related to the use of numerous measures for adverse events in hospitals in the United States. The authors explain how continually adding mandated safety measures can detract from safety improvement by overwhelming hospital workers with the burden of tracking and failing to record new types of errors.

Using the Agency for Healthcare Research and Quality's (AHRQ) patient safety indicators, the researchers analyzed a nationwide hospital discharge sample and found inconsistent relationships between the type of hospital and adverse events.

Postoperative complications are key measures of surgical safety and quality. This analysis of electronic health record data found that AHRQ Patient Safety Indicators of surgical complications were more common in patients with obesity. The authors suggest that systems approaches are needed to mitigate surgical risk for patients with obesity.

Failure to rescue is both a concept and a measure of hospital quality and safety. The concept captures the idea that systems should be able to rapidly identify and treat complications when they occur, while the measure has been defined as the inability to prevent death after a complication develops.

The AHRQ Patient Safety Indicators (PSIs) use hospitals' administrative data to measure quality and carry financial consequences for hospitals as part of pay-for-performance initiatives. Prior research has raised concerns about the validity of PSIs compared with directly using clinical data to identify safety events. AHRQ recently restructured PSI-90 (a composite measure containing multiple distinct PSIs) from volume-based to harm-based weighting. Using data from 132 Veterans Health Administration hospitals, this retrospective study compared hospital performance using the previous PSI-90 with performance under the redesigned measure. Although there was strong association between the volume-based and harm-based PSI-90 measures, use of the harm-based version had a significant impact on pay-for-performance because of changes in the weights of the component measures. Approximately 15% of hospitals in the study would face changes in financial penalties under the Hospital-Acquired Condition Reduction Program when using the new PSI-90. A past PSNet perspective discussed the impact of pay-for-performance.

Hospitals and health care providers are developing new ways to involve patients and families in safety efforts. This report discusses a National Health Service program designed to enhance feedback opportunities from consumers and assess these initiatives. Although the investigators found no direct care improvements associated with the interventions, the approaches they used to test patient engagement strategies (such as the ability to raise concerns) were successful.

Hospital quality rankings, though widely-used, remain controversial. This validation study found inaccuracies in the U.S. News and World Report hospital rankings when compared with Centers for Medicare and Medicaid–measured rates of safety events. The authors state that in response to their findings, the U.S. News and World Report revised their ranking method and data sources.

AHRQ Patient Safety Indicators (PSIs) have been utilized to identify safety problems and suboptimal care quality in acute care settings using ICD-9 codes in administrative discharge data. Despite limitations in the accuracy of PSIs, they have been widely employed as a quality metric. The implementation of ICD-10 and diagnosis timing codes necessitate development of a new set of PSIs. This consensus and validation study used a Delphi panel process to determine ICD-10 codes associated with safety and quality concerns. Experts grouped the 640 identified diagnostic codes into 18 PSI categories. Application of these novel PSIs in over 10 years of hospital discharge data uncovered safety problems in 5% of hospitalizations. The authors recommend that these proposed PSIs should be further validated using record review or prospective case review.

The AHRQ Patient Safety Indicators (PSIs) represent quality measures derived from administrative data. However, concerns about validity have led to increased scrutiny. This retrospective study analyzed all PSIs identified by standard algorithms over a 1-year period at a single academic medical center. A review team reversed 185 of the 657 PSIs initially identified, citing the two main reasons for reversal to be algorithm limitations and coding misinterpretations. The authors concluded that if PSIs continue to be publicly reported and carry financial implications for hospitals, the quality of administrative data and accuracy of PSI algorithms must be improved.

The AHRQ Patient Safety Indicators (PSIs) rely on hospital administrative data to screen for patient safety problems. This study used independent physician chart review to assess the reliability of PSI 11 (postoperative respiratory failure) in identifying clinically significant patient safety events and found a positive predictive value of 38.3%. The authors argue that PSI 11 should not be used as a measure for hospital performance.

Patient-centeredness is considered a crucial aspect of high quality care. Patient satisfaction measures represent increasingly important quality measures for both inpatient and ambulatory care and may have implications for health care outcomes. Investigators analyzed the relationship between patient experience scores and patient safety indicators (PSIs) for more than 25,000 patients across 93 hospitals in Alberta, Canada. The presence of one or more PSIs was associated with decreased odds of having high overall, physician, and nurse ratings during hospitalization. The authors concluded that patient experience ratings are an important indicator of health care quality and that including the patient perspective may help to enhance patient safety.

This toolkit provides resources to help hospitals to augment safety. The updated toolkit represents adjustments made to the AHRQ Quality Indicators to support the transition from ICD-­9 to ICD-­10, experience from testing in hospitals, and materials targeted to inform leadership of the program. The toolkit is structured around enhancing multidisciplinary teamwork by completing a series of steps such as assessing the organizational readiness for a change initiative, implementing improvements, and determining the return on investment of the programs.

The ability to use administrative data to measure patient safety is critical, because chart review is time-consuming and resource-intensive. The AHRQ Patient Safety Indicators (PSIs) and the CMS Hospital-acquired Conditions (HACs) aim to measure and track patient safety using administrative data. PSIs are often used for pay-for-performance, and CMS has a policy of nonpayment for hospitalizations associated with HACs. This systematic review found that PSIs and HACs have not been adequately validated compared to chart review and therefore may be subject to coding error. Establishing hospital quality or payment based on unvalidated metrics has consequences for patient safety efforts. These results suggest that unless further development and validation of administrative metrics occurs, widespread implementation of pay-for-performance efforts may not significantly improve patient safety.

This study updates the previously described progress of patient safety efforts at Johns Hopkins Hospital. In 2012, hospital leaders declared their goal of exceeding The Joint Commission Top Performer award thresholds by achieving at least 96% compliance on accountability measures. The program included creating a robust quality management infrastructure through the Armstrong Institute, engaging frontline clinicians in peer learning communities, and transparently reporting monthly data with a detailed step-based accountability plan for underachieving metrics. This study describes how the hospital was able to sustain performance on all of the accountability measures through 2014. The authors attribute their continued success to establishing an enduring quality management infrastructure, a project management office, and a formal accountability framework. This model highlights the degree of organization required to create lasting changes that improve patient safety across health systems.

The AHRQ Patient Safety Indicators (PSIs) can identify adverse events in hospital data. This study demonstrated that PSIs were associated with longer hospital stays and increased mortality. Neurosurgery patients were more likely to have PSIs occur than other surgical patients.

Examining patient safety indicator (PSI) events at a single academic hospital, this study found that up to one-third of reported events were due to the disease process rather than a patient safety problem, and between 11%–30% of events were not clinically significant. The authors argue that PSIs as currently reported should not be used for ranking hospitals.

Hospital-acquired conditions (HACs) are thought to be preventable, and the Centers for Medicare and Medicaid Services reduces payments to hospitals with the highest rates of these conditions. This analysis sought to assess the association between measures of hospital quality, such as accreditation, and penalties for HACs. Researchers found that accredited hospitals were more likely to incur HAC penalties. Teaching institutions, hospitals whose case mix included more complex patients, and safety-net hospitals were all more likely to face penalties than nonteaching, nonsafety institutions with healthier patients. These results add weight to concerns about unintended consequences of pay-for-performance programs leading to widening health disparities and selective treatment, or "cherry-picking" of healthier patients. A related editorial co-authored by two United States Senators calls for including socioeconomic status in the HAC penalty formula.

This study sought to examine whether events captured by Patient Safety Indicators (PSIs) explain the "weekend effect" of higher hospital mortality. Researchers found that rates of PSI events were similar, but weekend instances of PSI events in general have worse outcomes than those on weekdays. This suggests that adverse events and the responses to adverse events are suboptimal on weekends, arguing for enhancements of weekend staffing.

This study used discharge data from hospitals in 11 states to see whether the rate of adverse patient safety events within the same hospital differed based on a patient's insurance status. Risk-adjusted rates of 13 AHRQ Patient Safety Indicators (PSIs) were measured. Patients with private insurance experienced significantly fewer adverse events compared to Medicare and Medicaid patients. However, these findings were not consistent across event types—Medicaid patients had lower event rates on two of the PSIs. These findings raise serious concerns about quality disparities within the same hospital, though there are many methodological limitations to the study such as the ability to accurately risk-adjust patients based on discharge data and whether PSIs provide a valid measurement of safety. A prior AHRQ WebM&M perspective reviewed different methods for measuring patient safety and the limitations of each tool.

Analyzing data from the Hospital Consumer Assessment of Healthcare Providers and Systems, this report discusses hospital efforts to understand measures of patient experience and reveals how 32 institutions recognized for their patient safety status were found to have had improved outcomes over time as demonstrated through the application of patient safety indicators. The publication includes a list of hospitals that received the 2015 Healthgrades Patient Safety Excellence Award.