AHRQ Quality Indicators Patient Safety Indicators: Technical Specifications Department of Health and Human Services Agency for Healthcare Research and Quality http://www.qualityindicators.ahrq.gov March 2003 Version 3.1 (March 12, 2007) AHRQ Quality Indicators Web Site: http://www.qualityindicators.ahrq.gov Table of Contents About the Patient Safety Indicators ............................................................................................................... 1 Patient Safety Indicators – Detailed Definitions ............................................................................................ 3 Complications of Anesthesia (PSI 1) ............................................................................................................ 3 Death in Low-Mortality DRGs (PSI 2) ........................................................................................................... 5 Decubitus Ulcer (PSI 3) ................................................................................................................................. 7 Failure to Rescue (PSI 4) .............................................................................................................................. 9 Foreign Body Left during Procedure, Secondary Diagnosis Field (PSI 5 and 21)...................................... 17 Iatrogenic Pneumothorax, Secondary Diagnosis Field (PSI 6 and 22)....................................................... 18 Selected Infections Due to Medical Care, Secondary Diagnosis Field (PSI 7 and 23) .............................. 23 Postoperative Hip Fracture (PSI 8) ............................................................................................................. 24 Postoperative Hemorrhage or Hematoma (PSI 9 and 27) .......................................................................... 28 Postoperative Physiologic and Metabolic Derangement (PSI 10) .............................................................. 29 Postoperative Respiratory Failure (PSI 11) ................................................................................................ 31 Postoperative Pulmonary Embolism or Deep Vein Thrombosis (PSI 12) ................................................... 33 Postoperative Sepsis (PSI 13) .................................................................................................................... 33 Postoperative Wound Dehiscence (PSI 14 and 24) ................................................................................... 34 Accidental Puncture or Laceration, Secondary Diagnosis Field (PSI 15 and 25)....................................... 41 Transfusion Reaction, Secondary Diagnosis Field (PSI 16 and 26) ........................................................... 41 Birth Trauma―Injury to Neonate (PSI 17) .................................................................................................. 43 Obstetric Trauma―Vaginal Delivery with Instrument (PSI 18) ................................................................... 44 Obstetric Trauma―Vaginal Delivery without Instrument (PSI 19) .............................................................. 45 Obstetric Trauma―Cesarean Delivery (PSI 20) ......................................................................................... 46 Appendix A: Operating Room Procedure Codes ..................................................................................... A-1 Appendix B: Surgical Discharge DRGs .................................................................................................... B-1 Appendix C: ICD-9-CM Trauma Diagnosis Codes................................................................................... C-1 Appendix D: ICD-9-CM Codes for Immunocompromised States ............................................................. D-1 Appendix E: Cancer Codes ...................................................................................................................... E-1 Appendix F: Medical Discharge DRGs ..................................................................................................... F-1 Appendix G: Hemorrhage Diagnosis Codes ............................................................................................. G-1 Appendix H: Shock Diagnosis Codes ...................................................................................................... H-1 Appendix I: ICD-9-CM Gastrointestinal (GI) Hemorrhage Diagnosis Codes ............................................ I-1 Appendix J: Trauma DRGs ....................................................................................................................... J-1 Appendix K: Pulmonary Embolism/Deep Vein Thrombosis Diagnosis Codes ........................................ K-1 Appendix L: Self-Inflicted Injury Diagnosis Codes .................................................................................... L-1 Appendix M: Acute Myocardial Infarction (AMI) Diagnosis Codes .......................................................... M-1 Appendix N: Cardiac Arrhythmia Diagnosis Codes ................................................................................. N-1 Appendix O: Sepsis Diagnosis Codes ..................................................................................................... O-1 Appendix P: Infection Diagnosis Codes and DRGs ................................................................................. P-1 Appendix Q: Cancer DRGs ....................................................................................................................... Q-1 Appendix R: Links .................................................................................................................................... R-1 PSI Technical Specifications iii Version 3.1 (March 12, 2007 AHRQ Quality Indicators Web Site: http://www.qualityindicators.ahrq.gov About the Patient Safety Indicators The PSIs are a set of measures that can be used with hospital inpatient discharge data to provide a perspective on patient safety. Specifically, PSIs screen for problems that patients experience as a result of exposure to the healthcare system and that are likely amenable to prevention by changes at the system or provider level. These are referred to as complications or adverse events. PSIs are defined on two levels: the provider level and the area level. This document provides all ICD-9-CM and DRG codes included in or excluded from the numerator and denominator for each indicator in the Patient Safety Indicators. Version 3.1 of the AHRQ PSIs reflects changes in indicators associated with ICD-9-CM and DRG coding updates for FY 2007 (effective 10-1- 2006). The reference population database used by the software was updated to HCUP’s Year 2004 State Inpatient Data (SID) for 36 states. The 2002-2004 SID is the basis for DRGs with a less than 0.05% mortality rate that are used in PSI #2, Death in Low-mortality DRGs. Information about the development of the indicators and their definitions is contained in the companion document Guide to the Patient Safety Indicators. See Appendix R for links to these and other documents as well as Web sites that may be of interest to PSI users. Software to calculate the PSI rates is available for download from the AHRQ Quality Indicators Web site in two formats: A set of SAS® programs and accompanying documentation QI Windows Application The SAS version requires the SAS® statistical program distributed by the SAS Institute, Inc. The company may be contacted directly regarding the licensing of its products: http://www.sas.com The Windows version calculates rates for all of the AHRQ Quality Indicators modules. Users do not need to purchase any additional software to run this program. Both versions of the software: Assign and calculate PSIs from hospital discharge abstracts or UB (uniform billing) claims data. Print PSI results in a format that can be imported into word processing documents, spreadsheets, or graphics software, at the user's option. Create risk-adjusted rates that adjust for case mix differences and expected rates that adjust for performance differences. Create smoothed (i.e., reliability-adjusted) rates that reduce fluctuations over time due to random variation. The FY2007 release includes enhancements to the functionality of the risk-adjustment module. Users will be able to save the discharge level file of predicted values based on the risk-adjustment model. As a result, users will be able to compute observed-to-expected ratios for any combination of discharges. In addition, the module will compute risk-adjusted rates for the pre-defined set of stratification variables (e.g., age, gender, payer, race), and will provide an option for using weighted data (i.e., discharge weights like those used in the NIS). PSI Technical Specifications 1 Version 3.1 (March 12, 2007 AHRQ Quality Indicators Web Site: http://www.qualityindicators.ahrq.gov Effective March 1, 2007 the UB-04 data specification manual will include a Present on Admission indicator (http://www.nubc.org/public/whatsnew/POA.pdf). The FY2007 release of the AHRQ QI includes an option to incorporate the present on admission indicator into the specifications of the Patient Safety Indicators (PSI) and the Pediatric Quality Indicators (PedQI). In general, cases where the outcome of interest is present on admission will be excluded from the denominator, as these cases are no longer at risk of having the outcome of interest occur during the hospitalization. Users can compute risk adjustment with or without