Patient Safety

2011 National Healthcare Quality and Disparities Reports

The National Healthcare Quality Report (NHQR) is a comprehensive national overview of quality of health care in the United States. It is organized around four dimensions of quality of care: effectiveness, patient safety, timeliness, and patient centeredness.

Healthcare-Associated Infections
Adult surgery patients with postoperative catheter-associated urinary tract infection
Composite measure: Adult surgery patients who received eight recommended care practices
Adult surgery patients who received prophylactic antibiotics within 1 hour prior to surgical incision
Adult surgery patients who had prophylactic antibiotics discontinued within 24 hours after surgery end time
Postoperative septicemia per 1,000 elective surgical hospital discharges of 4 or more days
Selected infections due to medical care per 1,000 hospital discharges

Surgical Care
Adult surgery patients with postoperative complications
Adult surgery patients with postoperative pneumonia events
Adult surgery patients with postoperative venous thromboembolic events
Postoperative hemorrhage or hematoma with surgical drainage or evacuation
Postoperative pulmonary embolism (PE) or deep vein thrombosis (DVT) per 1,000 surgical hospital discharges
Postoperative respiratory failure per 1,000 elective surgical hospital discharges
Postoperative physiologic/metabolic derangements per 1,000 elective surgical hospital discharges
Postoperative hip fractures per 1,000 surgical hospital discharges
Reclosure of postoperative abdominal wound separation per 1,000 abdominopelvic-surgery hospital discharges
Foreign body left in during procedure
Complications of anesthesia per 1,000 surgical hospital discharges
Adverse events in patients receiving hip joint replacement due to degenerative conditions
Adverse events in patients receiving hip joint replacement due to fracture
Adverse events in patients receiving hip joint replacement due to fracture or degenerative conditions
Adverse events in patients receiving knee joint replacement

Other Complications of Hospital Care
Accidental puncture or laceration during procedure
Composite measure: Discharges with central venous catheter (CVC) placement with associated bloodstream infections (BSIs) or mechanical adverse events
Discharges with central venous catheter placement with associated bloodstream infections (BSIs)
Discharges with central venous catheter placement with associated mechanical adverse events
Iatrogenic pneumothorax
Decubitus ulcers per 1,000 hospital discharges with a length of stay of 5 or more days
Transfusion reactions
Deaths per 1,000 discharges with complications potentially resulting from care (failure to rescue)
Deaths per 1,000 discharges in low-mortality diagnosis-related groups (DRGs)
Patients with hospital-acquired pressure ulcers
Deaths per 1,000 hospital admissions with pneumonia as principal diagnosis

Complications of Medication
Hospital patients with an anticoagulant-related adverse drug event with warfarin
Hospital patients with an anticoagulant-related adverse drug event with IV heparin
Hospital patients with an anticoagulant-related adverse drug event with low-molecular-weight heparin (LMWH) or factor Xa
Hospital patients with an adverse drug event with a hypoglycemic agent

Other Complications
Ambulatory medical care visits due to adverse effects of medical care per 1,000 people

Healthcare-Associated Infections

Measure Title

Adult surgery patients with postoperative catheter-associated urinary tract infection.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Tables

12_1_1.1 Surgical discharges with catheter-associated urinary tract infection, United States, 2005-2009

National Data Source

CMS, MPSMS.

National Denominator

All surgical patients from the MPSMS sample with documented placement of a urinary catheter.

National Numerator

Subset of the denominator with a diagnosis of a postoperative catheter-associated urinary tract infection.

Comment

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used for postdischarge, readmission, and clinical criteria processing, as appropriate for each component of the composite measure.

MPSMS is a nationwide surveillance system designed to identify rates of specific adverse events within the hospitalized fee-for-service Medicare population. An adverse event is defined as an unintended patient harm, injury, or loss more likely associated with the patient's interaction with the health care delivery system than from diseases the patient may have.

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Healthcare-Associated Infections

Measure Title

Composite measure: Adult surgery patients who received eight recommended care practices.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Quality Improvement Organization Program (QIO).

National Tables

12_1_2.1 Surgery patients who received recommended care practices, United States, 2009

National Data Source

CMS, QIO.

National Denominator

Discharged adult hospital patients with indication of surgery.

National Numerator

Subset of the denominator who received all eight recommended care practices included in the composite:

Antibiotic within 1 hour of surgery (SCIP-1).
Appropriate antibiotic to help prevent infection (SCIP-2).
Discontinuation of antibiotic on time (SCIP-3).
Blood sugar level under good control right after surgery for cardiac surgery patients (SCIP-4).
Removal of hair from the surgical area using a safer method (SCIP-6).
Patients whose doctors ordered thromboembolism prophylaxis for prevention of blood clots after certain surgeries (SCIP-VTE1).
Appropriate venous thromboembolism prophylaxis within 24 hours prior to and after surgery (SCIP-VTE2).
Beta blocker therapy prior to arrival and during the postoperative period (SCIP-Card2).

State Table

12_1_2.2 Surgery patients who received recommended care practices, by State, United States, 2009

State Data Source

CMS, QIO.

State Denominator

Same as national.

State Numerator

Same as national.

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Healthcare-Associated Infections

Measure Title

Adult surgery patients who received prophylactic antibiotics within 1 hour prior to surgical incision.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Quality Improvement Organization Program (QIO).

National Table

12_1_3.1 Adult surgery patients who received prophylactic antibiotics within 1 hour prior to surgical incision, United States, 2005-2009

National Data Source

CMS, QIO.

National Denominator

Discharged adult hospital patients with indication of surgery.

National Numerator

Subset of the denominator who had prophylactic antibiotics within 1 hour prior to surgery.

State Table

12_1_3.2 Adult surgery patients who received prophylactic antibiotics within 1 hour prior to surgical incision, by State, United States, 2005-2009

State Data Source

CMS, QIO.

State Denominator

Same as national.

State Numerator

Same as national.

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Healthcare-Associated Infections

Measure Title

Adult surgery patients who had prophylactic antibiotics discontinued within 24 hours after surgery end time.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Quality Improvement Organization Program (QIO).

National Table

12_1_4.1 Adult surgery patients who had prophylactic antibiotics discontinued within 24 hours after surgery end time, United States, 2005-2009

National Data Source

CMS, QIO.

National Denominator

Discharged adult hospital patients with indication of surgery.

National Numerator

Subset of the denominator who had prophylactic antibiotics discontinued within 24 hours after surgery end time.

State Table

12_1_4.2 Adult surgery patients who had prophylactic antibiotics discontinued within 24 hours after surgery end time, by State, United States, 2005-2009

State Data Source

CMS, QIO.

State Denominator

Same as national.

State Numerator

Same as national.

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Healthcare-Associated Infections

Measure Title

Postoperative septicemia per 1,000 elective surgical hospital discharges of 4 or more days.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

12_1_5.1 Postoperative sepsis per 1,000 elective-surgery admissions with a length of stay of 4 or more days, age 18 and over, United States, 2008

12_1_5.2 Postoperative sepsis per 1,000 elective-surgery admissions with a length of stay of 4 or more days, age 18 and over, by race/ethnicity, United States, 2008

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1.

National Denominator

All elective hospital surgical discharges among people age 18 or over with a length of stay of 4 or more days.

National Numerator

Subset of the denominator with any secondary diagnosis of sepsis.

State Table

12_1_5.3 Postoperative sepsis per 1,000 elective-surgery admissions with a length of stay of 4 or more days, age 18 and over, by State, United States, 2008

State Data Source

AHRQ, CDOM, HCUP, AHRQ Quality Indicators, modified version 4.1 and State Inpatient Databases (SID).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

The AHRQ PSI software requires that the sepsis be reported as a secondary diagnosis (rather than the principal diagnosis). but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. In addition, the sepsis is not verifiable as following surgery. Consistent with the AHRQ PSI software, the following cases are excluded: admissions with a principal diagnosis of infection, admissions with cancer or in an immunocompromised state, and obstetric admissions. Rates prior to 2008 are not reported because of International Classification of Diseases, Ninth Revision coding changes.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, major diagnostic category (MDC), diagnosis-related group (DRG), and transfers to the hospital. When reporting is by age, the adjustment is by gender, comorbidities, MDC, DRG, and transfers to the hospital; when reporting is by gender, the adjustment is by age, comorbidities, MDC, DRG, and transfers to the hospital. The AHRQ PSI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).

Although not all States participate in the HCUP database, NIS is weighted to give national estimates using weights based on all U.S. community, nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

SID includes a powerful set of hospital databases from data organizations in participating States. SID contains the universe of the inpatient discharge abstracts in participating States, translated into a uniform format to facilitate multi-State comparisons and analyses. Together, SID encompasses about 90% of all U.S. community hospital discharges. SID contains a core set of clinical and nonclinical information on all patients, regardless of payer, including people covered by Medicare, Medicaid, and private insurance, as well as uninsured people. In addition to the core set of uniform data elements common to all SID, some databases within SID include other elements, such as the patient's race.

The SID disparities analysis file is designed to provide national estimates on disparities using weighted records from a sample of hospitals from the following 31 States: Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Vermont, Wisconsin, and Wyoming.

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Healthcare-Associated Infections

Measure Title

Selected infections due to medical care per 1,000 hospital discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

12_1_6.1_1 Admissions with central venous catheter-related bloodstream infection per 1,000 medical and surgical discharges with a length of stay of 2 or more days, age 18 and over or obstetric admissions, United States, 2008

12_1_6.1_2 Admissions with central venous catheter-related bloodstream infection per 1,000 medical and surgical discharges with a length of stay of 2 or more days, age 18 and over or obstetric admissions, by race/ethnicity, United States, 2008

12_1_6.2_1 Admissions for central venous catheter-related bloodstream infections per 100,000 population, age 18 and over, United States, 2008

12_1_6.2_2 Admissions for central venous catheter-related bloodstream infections per 100,000 population, age 18 and over, by race/ethnicity, United States, 2008

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) disparities analysis file, and AHRQ Quality Indicators, modified version 4.1.

National Denominator

All medical and surgical hospital discharges or obstetric admissions, age 18 and over.

National Numerator

Subset of the denominator with any secondary diagnosis of infection.

Comments

The AHRQ PSI software requires that the central venous catheter-related bloodstream infection be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. Consistent with the AHRQ PSI software, the following cases are excluded: admissions with a diagnosis of cancer or in an immunocompromised state. Rates prior to 2008 are not reported because of International Classification of Diseases, Ninth Revision coding changes.

Rates are adjusted by comorbidities and diagnosis-related group (DRG). The AHRQ PSI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).

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Surgical Care

Measure Title

Adult surgery patients with postoperative complications.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

12_2_1.1 Surgical discharges with postoperative pneumonia events or venous thromboembolic events, United States, 2002-2007 and 2009

National Data Source

CMS, MPSMS.

National Denominator

All discharges from the MPSMS sample that had at least one of selected surgical procedures identified as part of the Surgical Care Improvement Project who did not have pneumonia or venous thromboembolic events prior to the procedure.

National Numerator

Subset of the denominator with postoperative pneumonia events or venous thromboembolic events.

Comments

Data were not collected in 2008. The 2002-2007 data include Medicare beneficiaries discharged from January to December and the 2009 data include Medicare beneficiaries discharged from January to September. Venous thromboembolic events include 30-day postoperative readmissions for pneumonia and venous thromboembolic events.

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Surgical Care

Measure Title

Adult surgery patients with postoperative pneumonia events.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

12_2_2.1 Surgical discharges with postoperative pneumonia events, United States, 2002-2007 and 2009

National Data Source

CMS, MPSMS.

National Denominator

All discharges from the MPSMS sample that had at least one of selected surgical procedures identified as part of the Surgical Care Improvement Project who did not have pneumonia prior to the procedure.

National Numerator

Subset of the denominator with a diagnosis of postoperative pneumonia.

Comments

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Surgical Care

Measure Title

Adult surgery patients with postoperative venous thromboembolic events.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

12_2_3.1 Surgical discharges with postoperative venous thromboembolic events, United States, 2002-2007 and 2009

National Data Source

CMS, MPSMS.

National Denominator

All discharges from the MPSMS sample that had one or more of certain surgical procedures identified as part of the Surgical Care Improvement Project during the index hospital stay.

National Numerator

Subset of the denominator with a diagnosed pulmonary embolism (PE) or deep vein thrombosis (DVT) during the index hospital stay (per medical record abstraction) or readmission to the hospital post-index hospital stay for a PE or DVT within 30 days of the surgical procedure.

Comments

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Surgical Care

Measure Title

Postoperative hemorrhage or hematoma with surgical drainage or evacuation.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

12_2_4.1_1 Postoperative hemorrhage or hematoma with surgical drainage or evacuation per 1,000 surgical admissions, age 18 and over, United States, 2000, 2004, 2005, 2007, and 2008

12_2_4.1_2 Postoperative hemorrhage or hematoma with surgical drainage or evacuation per 1,000 surgical admissions, age 18 and over, by race/ethnicity, United States, 2008

12_2_4.1_3 Postoperative hemorrhage or hematoma with surgical drainage or evacuation per 1,000 surgical admissions, age 18 and over, by income, United States, 2000-2008

12_2_4.2_1 Admissions for postoperative hemorrhage or hematoma per 100,000 population, age 18 and over, United States, 2000, 2004, 2005, 2007, and 2008

12_2_4.2_2 Admissions for postoperative hemorrhage or hematoma per 100,000 population, age 18 and over, by race/ethnicity, United States, 2008

12_2_4.2_3 Admissions for postoperative hemorrhage or hematoma per 100,000 population, age 18 and over, by income, United States, 2000-2008

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) disparities analysis file, and AHRQ Quality Indicators, modified version 4.1.

National Denominator

Discharge measure: Inpatient hospital surgical discharges age 18 and over, excluding obstetric admissions.

Population measure: U.S. population age 18 and over.

National Numerator

Discharge measure: Subset of the denominator with a secondary diagnosis indicating postoperative hemorrhage or postoperative hematoma.

Population measure: Subset of the denominator with any principal or secondary diagnosis of hemorrhage or postoperative hematoma.

Comments

The AHRQ PSI software requires that the hemorrhage or hematoma complicating procedure be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. In addition, the control of the hemorrhage or hematoma is not verifiable as following surgery. Consistent with the AHRQ PSI software, the following cases are excluded: obstetric conditions and admissions in which the control of the hemorrhage or hematoma is the only operating room procedure.

Rates are adjusted by gender, comorbidities, major diagnostic category (MDC), diagnosis-related group (DRG), and transfers to the hospital. When reporting is by gender, the adjustment is by comorbidities, MDC, DRG, and transfers to the hospital. The AHRQ PSI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).

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Surgical Care

Measure Title

Postoperative pulmonary embolism (PE) or deep vein thrombosis (DVT) per 1,000 surgical hospital discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs)

National Tables

12_2_5.1 Postoperative pulmonary embolism or deep vein thrombosis per 1,000 surgical admissions, age 18 and over, United States, 2000, 2004, 2005, 2007, and 2008

12_2_5.2 Postoperative pulmonary embolism or deep vein thrombosis per 1,000 surgical admissions, age 18 and over, by race/ethnicity, United States, 2008

12_2_5.3 Postoperative pulmonary embolism or deep vein thrombosis per 1,000 surgical admissions, age 18 and over, by income, United States, 2000-2008

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) disparities analysis file, and AHRQ Quality Indicators, modified version 4.1.

National Denominator

Hospital surgical patients, age 18 and over, excluding patients admitted for deep vein thrombosis or pulmonary embolism, obstetric admissions, and patients with secondary procedures for interruption of vena cava before or after surgery or as the only procedure.

National Numerator

Subset of the denominator with any secondary diagnosis of PE or DVT.

Comments

The AHRQ PSI software requires that the PE or DVT be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. In addition, the interruption of vena cava is not verifiable as following surgery. Consistent with the AHRQ PSI software, the following cases are excluded: obstetric conditions and admissions in which the interruption of vena cava is the only operating room procedure.

Rates are adjusted by age, comorbidities, major diagnostic category (MDC), diagnosis-related group (DRG), and transfers to the hospital. When reporting is by age, the adjustment is by comorbidities, MDC, DRG, and transfers to the hospital. The AHRQ PSI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).

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Surgical Care

Measure Title

Postoperative respiratory failure per 1,000 elective surgical hospital discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs) and Pediatric Quality Indicators (PDIs).

National Tables

12_2_6.1_1 Postoperative respiratory failure per 1,000 elective-surgery admissions, age 18 and over, United States, 2000, 2004, 2005, 2007, and 2008

12_2_6.1_2 Postoperative respiratory failure per 1,000 elective-surgery admissions, age 18 and over, by race/ethnicity, United States, 2008

12_2_6.1_3 Postoperative respiratory failure per 1,000 elective-surgery admissions, age 18 and over, by income, United States, 2000-2008

12_2_6.2_1 Postoperative respiratory failure per 1,000 elective-surgery admissions, age less than 18 years, United States, 2000, 2004, 2005, 2007, and 2008

12_2_6.2_2 Postoperative respiratory failure per 1,000 elective-surgery admissions, age less than 18 years, by race/ethnicity, United States, 2008

12_2_6.2_3 Postoperative respiratory failure per 1,000 elective-surgery admissions, age less than 18 years, by income, United States, 2000-2008

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) disparities analysis file, and AHRQ Quality Indicators, modified version 4.1.

National Denominator

All elective hospital surgical discharges (age 18 and over and less than 18), excluding patients with respiratory disease, circulatory disease, neuromuscular disorders, obstetric conditions, and secondary procedure of tracheostomy before or after surgery or as the only procedure.

National Numerator

Subset of the denominator with any secondary diagnosis of acute respiratory failure or reintubation procedure at specific postoperative intervals.

Comments

The AHRQ PSI software requires that the respiratory failure be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. In addition, the tracheostomy is not verifiable as following surgery. Consistent with the AHRQ PSI software, the following cases are excluded: admissions with respiratory disease, circulatory disease, craniofacial anomalies, or neuromuscular disorders; obstetric admissions; and admissions in which the tracheostomy is the only operating room procedure.

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Surgical Care

Measure Title

Postoperative physiologic/metabolic derangements per 1,000 elective surgical hospital discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Organization, Delivery, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

12_2_7.1 Postoperative physiologic and metabolic derangements per 1,000 elective-surgery admissions, age 18 and over, United States, 2000, 2004, 2005, 2007, and 2008

12_2_7.2 Postoperative physiologic and metabolic derangements per 1,000 elective-surgery admissions, age 18 and over, by race/ethnicity, United States, 2008

12_2_7.3 Postoperative physiologic and metabolic derangements per 1,000 elective-surgery admissions, age 18 and over, by income, United States, 2000-2008

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) disparities analysis file, and AHRQ Quality Indicators, modified version 4.1.

National Denominator

All elective hospital surgical discharges for people age 18 and over, excluding some serious diseases (see Comments) and obstetric admissions.

National Numerator

Subset of the denominator with any secondary diagnosis indicating physiologic and metabolic derangements; discharges with acute renal failure must be accompanied by a procedure code for dialysis.

Comments

The AHRQ PSI software requires that the physiologic and metabolic derangements be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. In addition, the derangement is not verifiable as following surgery. Consistent with the AHRQ PSI software, the following cases are excluded: cases with a preexisting condition of physiologic and metabolic derangements or chronic renal failure; cases with acute renal failure where a procedure for dialysis occurs before or on the same day as the first operating room procedure; cases with both a diagnosis code of ketoacidosis, hyperosmolarity, or other coma and a principal diagnosis of diabetes; cases with both a secondary diagnosis code for acute renal failure and a principal diagnosis of acute myocardial infarction, cardiac arrhythmia, cardiac arrest, shock, hemorrhage, or gastrointestinal hemorrhage; and obstetric admissions.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, major diagnostic category (MDC), and diagnosis-related group (DRG). When reporting is by age, the adjustment is by gender, comorbidities, MDC, and DRG; when reporting is by gender, the adjustment is by age, comorbidities, MDC, and DRG. The AHRQ PSI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).

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Surgical Care

Measure Title

Postoperative hip fractures per 1,000 surgical hospital discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

12_2_8.1 Postoperative hip fracture per 1,000 surgical admissions who were not susceptible to falling, age 18 and over, United States, 2000, 2004, 2005, 2007, and 2008

12_2_8.2 Postoperative hip fracture per 1,000 surgical admissions who were not susceptible to falling, age 18 and over, by race/ethnicity, United States, 2008

12_2_8.3 Postoperative hip fracture per 1,000 surgical admissions among patients who were not susceptible to falling, age 18 and over, by income, United States, 2000-2008

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) disparities analysis file, and AHRQ Quality Indicators, modified version 4.1.

National Denominator

Inpatient hospital surgical discharges, age 18 and over, who were not susceptible to falling.

National Numerator

Subset of the denominator with any secondary diagnosis indicating hip fracture.

Comments

The AHRQ PSI software requires that the hip fracture be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. In addition, the hip fracture repair is not verifiable as following surgery. Consistent with the AHRQ PSI software, the following cases are excluded: obstetric cases; admissions for seizure, syncope, stroke, coma, cardiac arrest, poisoning, trauma, delirium and other psychoses, anoxic brain injury, metastatic cancer, lymphoid/bone malignancy, or self-inflicted injury; admissions for diseases and disorders of the musculoskeletal system and connective tissue; and admissions in which hip fracture repair is the only operating room procedure.

Rates are adjusted by major diagnostic category (MDC). The AHRQ PSI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).

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Surgical Care

Measure Title

Reclosure of postoperative abdominal wound separation per 1,000 abdominopelvic-surgery hospital discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

12_2_9.1_1 Reclosure of postoperative abdominal wound dehiscence per 1,000 abdominopelvic-surgery admissions of length 2 or more days, age 18 and over, United States, 2000, 2004, 2005, 2007, and 2008

12_2_9.1_2 Reclosure of postoperative abdominal wound dehiscence per 1,000 abdominopelvic-surgery admissions of length 2 or more days, age 18 and over, by race/ethnicity, United States, 2008

12_2_9.1_4 Reclosure of postoperative abdominal wound dehiscence per 1,000 abdominopelvic-surgery admissions with a length of stay of 2 or more days, age 18 and over, by income, United States, 2000-2008

12_2_9.2_1 Admissions for reclosure of abdominal wound dehiscence per 100,000 population, age 18 and over, United States, 2000, 2004, 2005, 2007, and 2008

12_2_9.2_2 Admissions for reclosure of abdominal wound dehiscence per 100,000 population, age 18 and over, by race/ethnicity, United States, 2008

12_2_9.2_3 Admissions for reclosure of abdominal wound dehiscence per 100,000 population, age 18 and over, by income, United States, 2000-2008

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1.

National Denominator

Discharge measure: Inpatient hospital surgical (abdominopelvic surgery with a length of stay of 2 or more days) discharges age 18 and over, excluding obstetric admissions.

Population measure: U.S. population age 18 and over.

National Numerator

Discharge measure: Subset of the denominator with a secondary procedure indicating reclosure of postoperative disruption of abdominal wall.

Population measure: Subset of the denominator with a secondary procedure indicating reclosure of postoperative disruption of abdominal wall.

State Table

12_2_9.1_3 Reclosure of postoperative abdominal wound dehiscence per 1,000 abdominopelvic-surgery discharges with a length of stay of 2 or more days, age 18 and over, by State, United States, 2000, 2004, 2007, and 2008

State Data Source

AHRQ, CDOM, HCUP, State Inpatient Databases (SID).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Reclosure of abdominal wound dehiscence is not verifiable as following surgery and may have occurred on or before the abdominopelvic procedure. Consistent with the AHRQ PSI software, the following cases are excluded: obstetric admissions and admissions in an immunocompromised state.

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Surgical Care

Measure Title

Foreign body left in during procedure.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSIs).

National Tables

12_2_10.2_1 Admissions for foreign body accidentally left in during procedure per 100,000 population, age 18 and over, United States, 2000, 2004, 2005, 2007, and 2008

12_2_10.2_2 Admissions for foreign body accidentally left in during procedure per 100,000 population, age 18 and over, by race/ethnicity, United States, 2008

12_2_10.2_3 Admissions for foreign body accidentally left in during procedure per 100,000 population, age 18 and over, by income, United States, 2000-2008

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) disparities analysis file, and AHRQ Quality Indicators, modified version 4.1.

National Denominator

U.S. population age 18 and over, excluding patients with International Classification of Diseases, Ninth Revision codes for foreign body left during procedure in principal diagnosis field or secondary diagnosis present on admission.

National Numerator

Subset of the denominator with any principal or secondary diagnosis indicating foreign body left in during procedure.

Comments

No risk adjustment is performed for discharge measures. Population measures are adjusted by age and gender using the total U.S. population for 2000 as the standard population.

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Surgical Care

Measure Title

Complications of anesthesia per 1,000 surgical hospital discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Utilization and Cost Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

Not reported in the 2011 NHQR and NHDR.

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators.

National Denominator

All surgical hospital discharges age 18 or over, excluding patients with poisoning due to anesthetics, active drug dependence, active nondependent abuse of drugs, or self-inflicted injury.

National Numerator

Subset of the denominator with any secondary diagnosis indicating anesthesia complications/

Comments

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Surgical Care

Measure Title

Adverse events in patients receiving hip joint replacement due to degenerative conditions.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

12_2_12.1 Adverse events in patients receiving hip joint replacement due to degenerative conditions, United States, 2002-2007 and 2009

National Data Source

CMS, MPSMS.

National Denominator

All Medicare fee-for-service (FFS) discharges in the MPSMS sample who experienced a surgical procedure performed to replace a damaged hip joint.

National Numerator

Subset of the denominator who experienced at least one of the following:

Postoperative infections (acute or early deep ), dehiscence, necrosis, hematoma, nerve injury, major bleeding, dislocation, cardiovascular complications, catheter-associated urinary tract infection or pneumonia..
Return to operating room after procedure (excludes same side revision).
Revision during the index hospital stay (same side as index procedure).
Postoperative venous thromboembolic event during hospital stay (per abstracted information from medical records).
Readmission to the hospital post-index hospital stay for a pulmonary embolism (PE) or deep vein thrombosis (DVT) within 30 days of the surgical procedure.

Comments

Postoperative infections are determined by documentation of early prosthetic joint or wound infection or acute and early deep hip infection, excluding superficial infection. Wound complications other than infection include dehiscence, hematoma, and necrosis.

The definition of major bleeding/hematoma underwent revision between January 1, 2002, and December 31, 2003. Rates for 2003 and later may not be comparable with earlier years.

Postoperative pneumonia, postoperative urinary tract infection, and postoperative venous thromboembolic event are all determined in the same fashion as those in other MPSMS measures. Cardiovascular complications include myocardial infarction, congestive heart failure, and arrhythmia requiring treatment.

The analytic approach used to produce these tables differs from the 2005 NHQR and NHDR and earlier reports. Data may not be comparable with those years.

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used for to determine 30-day postprocedure mortality, to distinguish between hip procedures, to determine 30-day postprocedure readmission for DVT or PE, and to identify readmission within 30 days of procedure.

MPSMS is a nationwide surveillance system designed to identify rates of specific adverse events within the hospitalized Medicare FFS population. An adverse event is defined as an unintended patient harm, injury, or loss more likely associated with the patient's interaction with the health care delivery system than from diseases the patient may have.

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Surgical Care

Measure Title

Adverse events in patients receiving hip joint replacement due to fracture.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

12_2_13.1 Adverse events in patients receiving hip joint replacement due to fracture, United States, 2002-2007 and 2009

National Data Source

CMS, MPSMS.

National Denominator

All Medicare fee-for-service (FFS) discharges in the MPSMS sample who experienced a surgical procedure performed to replace a fractured hip joint.

National Numerator

Subset of the denominator who experienced at least one of the following:

Postoperative infections.
Postoperative pneumonia.
Postoperative urinary tract infection.
Postoperative deep vein thrombosis (DVT) or pulmonary embolism (PE).
Dislocation.
Wound complications other than infection.
Nerve injury.
Postoperative bleeding requiring four or more blood transfusions.
Cardiovascular complications.
Same side revision during the index hospital stay.
Return to the operating room for reasons other than same side revision during the index hospital stay.
Death.

Comments

Postoperative infections are determined by documentation of early prosthetic joint or wound infection and acute and early deep hip infection, excluding superficial infection. Postoperative pneumonia, postoperative urinary tract infection, postoperative DVT, and PE are all determined in the same fashion as those in prior MPSMS measures. Cardiovascular complications include myocardial infarction, congestive heart failure, and arrhythmia requiring treatment. Wound complications other than infection include dehiscence, hematoma, and necrosis.

The analytic approach used to produce these tables differs from the 2005 NHQR and NHDR and earlier reports. Data may not be comparable with those years.

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used to determine 30-day postprocedure mortality, to distinguish between hip procedures, to determine 30-day postprocedure readmission for DVT or PE, and to identify readmission within 30 days of procedure.

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Surgical Care

Measure Title

Adverse events in patients receiving hip joint replacement due to fracture or degenerative conditions.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

12_2_14.1 Adverse events in patients receiving hip joint replacement due to fracture or degenerative conditions, United States, 2004-2007 and 2009

National Data Source

CMS, MPSMS.

National Denominator

All Medicare fee-for-service (FFS) discharges in the MPSMS sample who experienced a surgical procedure performed to replace an arthritic or damaged hip joint.

National Numerator

Subset of the denominator who experienced at least one of the following:

Postoperative acute or early deep infection.
Postoperative wound separation.
Postoperative necrosis.
Postoperative hematoma.
Postoperative nerve injury.
Postoperative major bleeding/hematoma.
Postoperative dislocation.
Postoperative cardiovascular complications.
Return to the operating room after procedure (excludes same-side revision during the index hospital stay).
Revision during the index hospital stay (same side as index procedure).
Postoperative periprosthetic fracture.
Postoperative venous thromboembolic event:
- During hospital stay (per abstracted information from medical records).
- Readmission to the hospital post-index hospital stay for a pulmonary embolism or deep vein thrombosis within 30 days of the surgical procedure.
Postoperative catheter-associated urinary tract infection.
Postoperative pneumonia.

Comments

Data were not collected in 2008. The 2004-2007 data include Medicare beneficiaries discharged from January to December and the 2009 data include Medicare beneficiaries discharged from January to September.

Postoperative infections are determined by documentation of:

Early prosthetic joint or wound infection.
Acute and early deep hip infection, excluding superficial infection.

Postoperative pneumonia, postoperative venous thromboembolic events, and catheter-associated urinary tract infections are determined using the same methods as those in prior MPSMS measures. Cardiovascular complications include myocardial infarction, congestive heart failure, and arrhythmia requiring treatment. Major bleeding/hematoma is defined as:

Return to the operating room for evacuation or hemostasis.
Hemoglobin drop of more than 2.0 g/dL compared with the value obtained on the first postoperative day (for example, a drop of 13.1 to 11.1 g/dL).

Differences in the hip replacement measure specifications between 2002 discharges and 2003-2007 discharges include:

Revision of the definition of major bleeding/hematoma.
Addition of periprosthetic fracture to the numerator as an adverse event in 2003-2007.

Differences in the hip replacement measure specifications between 2004 and 2005-2007 discharges include:

Revision of the postoperative urinary tract infection measure to catheter-associated urinary tract infection in 2005.

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Surgical Care

Measure Title

Adverse events in patients receiving knee joint replacement.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

12_2_15.1 Adverse events in patients receiving knee joint replacement, United States, 2002-2007 and 2009

National Data Source

CMS, MPSMS.

National Denominator

All Medicare fee-for-service (FFS) discharges in the MPSMS sample who experienced a surgical procedure performed to replace an arthritic or damaged knee joint.

National Numerator

Subset of the denominator who experienced at least one of the following:

Postoperative acute or early deep infection.
Postoperative wound separation.
Postoperative necrosis.
Postoperative hematoma.
Postoperative nerve injury.
Postoperative major bleeding/hematoma.
Postoperative cardiovascular complications.
Return to the operating room after procedure (excludes same-side revision during the index hospital stay).
Revision during the index hospital stay (same side as index procedure).
Postoperative periprosthetic fracture.
Postoperative venous thromboembolic event:
- During hospital stay (per abstracted information from medical records).
- Readmission to the hospital post-index hospital stay for a pulmonary embolism (PE) or deep vein thrombosis (DVT) within 30 days of the surgical procedure.
Postoperative catheter-associated urinary tract infection.
Postoperative pneumonia.

Comments

Postoperative infections are determined by documentation of:

Early prosthetic joint or wound infection.
Acute and early deep knee infection, excluding superficial infection.

Major bleeding/hematoma is defined as:

Return to the operating room for evacuation or hemostasis.
Hemoglobin drop of more than 2.0 g/dL compared with the value obtained on the first postoperative day (for example, a drop of 13.1 to 11.1 g/dL).

Differences in the knee replacement measure specifications between 2004 and 2005-2007 discharges include:

Revision of the definition of major bleeding/hematoma.
Addition of periprosthetic fracture to the numerator as an adverse event in 2003-2007.

Differences in the knee replacement measure specifications between 2004 and 2005-2006 discharges follow:

Cardiovascular complications include myocardial infarction, congestive heart failure, and arrhythmia requiring treatment.
Wound complications other than infection include dehiscence, hematoma, and necrosis.
Major bleeding/hematoma is defined as return to the operating room for evacuation or hemostasis, or hemoglobin drop of more than 2.0 g/dL compared with first postoperative day.

The analytic approach used to produce these tables differs from the 2005 NHQR and NHDR and earlier reports. Data may not be comparable with those years.

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used to determine 30-day postprocedure mortality, to determine 30-day postprocedure readmission for DVT or PE, and to identify readmission within 30 days of procedure.

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Other Complications of Hospital Care

Measure Title

Accidental puncture or laceration during procedure.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

Discharge tables:

12_3_2.1_1 Accidental puncture or laceration during procedure per 1,000 medical and surgical admissions, age 18 and over, United States, 2000, 2004, 2005, 2007, and 2008

12_3_2.1_2 Accidental puncture or laceration during procedure per 1,000 medical and surgical admissions, age 18 and over, by race/ethnicity, United States, 2008

12_3_2.1_3 Accidental punctures or lacerations per 1,000 medical and surgical admissions, age 18 and over, by income, United States, 2000-2008

12_3_2.2_1 Admissions with accidental puncture or laceration during procedure per 1,000 medical and surgical admissions, age less than 18 years, United States, 2000, 2004, 2005, 2007, and 2008

12_3_2.2_2 Admissions with accidental puncture or laceration during procedure per 1,000 medical and surgical admissions, age less than 18 years, by race/ethnicity, United States, 2008

12_3_2.2_3 Admissions with accidental puncture or laceration during per 1,000 medical and surgical admissions, age less than 18 years, by income, United States, 2000-2008

Population tables:

12_3_2.3_1 Admissions for accidental puncture or laceration during procedure per 100,000 population, age 18 and over, United States, 2000, 2004, 2005, 2007, and 2008

12_3_2.3_2 Admissions for accidental puncture or laceration during procedure per 100,000 population, age 18 and over, by race/ethnicity, United States, 2008

12_3_2.3_3 Admissions for accidental puncture or laceration during procedure per 100,000 population, age 18 and over, by income, United States, 2000-2008

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) disparities analysis file, and AHRQ Quality Indicators, modified version 4.1.

National Denominator

Discharge measures: Hospital medical and surgical discharges among people age 18 and under or age 18 and over, as appropriate, excluding obstetric admissions.

Population measures: U.S. population age 18 and over.

National Numerator

Discharge measures: Subset of the denominator with secondary diagnosis denoting accidental cut, puncture, perforation, or laceration during a procedure.

Population measures: Subset of the denominator with any principal or secondary diagnosis denoting accidental cut, puncture, perforation, or laceration during a procedure, such as cases from earlier admissions or from other hospitals.

Comments

The AHRQ PSI software requires that the accidental puncture or laceration be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. Consistent with the AHRQ PSI software, the following cases are excluded: obstetric admissions and admissions involving spinal surgery.

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Other Complications of Hospital Care

Measure Title

Composite measure: Discharges with central venous catheter (CVC) placement with associated bloodstream infections (BSIs) or mechanical adverse events.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

12_3_1.1 Discharges with central venous catheter placement with associated bloodstream infections or mechanical adverse events, United States, 2002-2007 and 2009

National Data Source

CMS, MPSMS.

National Denominator

All Medicare fee-for-service (FFS) discharges from the MPSMS sample with documentation of placement of at least one vascular access device terminating at, or close to, the heart or in one of the great vessels. The following are considered great vessels for this measure: aorta, vena cava, brachiocephalic veins, iliac vein, internal jugular veins, and subclavian veins that did not have evidence of a prior BSI.

National Numerator

Subset of the denominator with either a CVC-associated BSI or CVC-associated mechanical adverse event.

Comments

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Other Complications of Hospital Care

Measure Title

Discharges with central venous catheter placement with associated bloodstream infections (BSIs).

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Tables

12_3_3.1 Discharges with central venous catheter placement with associated bloodstream infections, United States, 2002-2007, 2009

National Data Source

CMS, MPSMS.

National Denominator

All Medicare fee-for-service (FFS) discharges from the MPSMS sample who did not have evidence of a prior BSI, with documentation of placement of at least one vascular access device, terminating at, or close to, the heart or in one of the great vessels. The following are considered great vessels for this measure: aorta, vena cava, brachiocephalic veins, iliac vein, internal jugular veins, and subclavian veins.

National Numerator

Subset of the denominator with a CVC-associated BSI.

Comments

CVC-associated BSI is determined by documentation of all of the following:

At least one blood culture, drawn at least 2 days after placement of a CVC, and positive for at least one of the following pathogens: Acinetobacter, beta-hemolytic streptococci, Candida, Candida glabrata, coagulase-negative staphylococci, Enterobacter spp., Enterococcus spp., Escherichia coli, Klebsiella spp., methicillin-resistant Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa, Pseudomonas other, Serratia marcescens, Staphylococcus aureus, Staphylococcus not otherwise specified, Staphylococcus other, viridans streptococci.
No other source of documented infection.

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Other Complications of Hospital Care

Measure Title

Discharges with central venous catheter placement with associated mechanical adverse events.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Tables

12_3_4.1 Central venous catheter placement with associated mechanical adverse events, United States, 2002-2007 and 2009

National Data Source

CMS, MPSMS.

National Denominator

All Medicare fee-for-service (FFS) discharges from the MPSMS sample with placement of at least one vascular access device terminating at, or close to, the heart or in one of the great vessels. The following are considered great vessels for this measure: aorta, vena cava, brachiocephalic veins, iliac vein, internal jugular veins, and subclavian veins.

National Numerator

Subset of the denominator with CVC-associated mechanical adverse events. A CVC-associated mechanical adverse event is defined as the presence in the medical record of at least one of the following:

Allergic reaction (only when CPR is performed within 15 minutes).
Perforation.
Pneumothorax.
Hematoma.
Shearing off of the catheter.
Air embolism.
Misplaced catheter.
Thrombosis/embolism.
Knotting of the pulmonary artery catheter.
Bleeding.
Catheter occlusion.
Leaking.
Other.

Comments

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Other Complications of Hospital Care

Measure Title

Iatrogenic pneumothorax.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

Discharge measures:

12_3_5.1_1 Iatrogenic pneumothorax per 1,000 medical and surgical admissions, age 18 and over, United States, 2000, 2004, 2005, 2007, and 2008

12_3_5.1_2 Iatrogenic pneumothorax per 1,000 medical and surgical admissions, age 18 and over, by race/ethnicity, United States, 2008

12_3_5.1_4 Iatrogenic pneumothorax per 1,000 medical and surgical admissions, age 18 and over, by income, United States, 2000-2008

Population measures:

12_3_5.2_1 Admissions for iatrogenic pneumothorax per 100,000 population, age 18 and over, United States, 2000, 2004, 2005, 2007, and 2008

12_3_5.2_2 Admissions for iatrogenic pneumothorax per 100,000 population, age 18 and over, by race/ethnicity, United States, 2008

12_3_5.2_3 Admissions for iatrogenic pneumothorax per 100,000 population, age 18 and over, by income, United States, 2000-2008

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1.

National Denominator

Discharge measure: All medical and surgical hospital discharges, age 18 and over, excluding patients with chest trauma or pleural effusion, thoracic surgery, lung or pleural biopsy, cardiac surgery, diaphragmatic surgery, or obstetric admissions.

Population measures: U.S. population age 18 and over.

National Numerator

Discharge measure: Subset of the denominator with any secondary diagnosis of iatrogenic pneumothorax.

Population measure: Subset of the denominator with any principal or secondary diagnosis of iatrogenic pneumothorax.

State Table

12_3_5.1_3 Admissions with iatrogenic pneumothorax per 1,000 medical and surgical discharges, age 18 and over, by State, United States, 2000, 2004, 2007, and 2008

State Data Source

AHRQ, CDOM, HCUP, State Inpatient Databases (SID).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

The AHRQ PSI software requires that the iatrogenic pneumothorax be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. Consistent with the AHRQ PSI software, the following cases are excluded: obstetric admissions and admissions with chest trauma, pleural effusion, thoracic surgery, lung/pleural biopsy, diaphragmatic surgery repair, or cardiac surgery.

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Other Complications of Hospital Care

Measure Title

Decubitus ulcers per 1,000 hospital discharges with a length of stay of 5 or more days.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

12_3_6.1 Admissions with stage III or IV pressure ulcers per 1,000 medical and surgical admissions with a length of stay of 5 or more days, age 18 and over, United States, 2000, 2004, 2005, 2007, and 2008

12_3_6.2 Admissions with stage III or IV pressure ulcers per 1,000 medical and surgical admissions with a length of stay of 5 or more days, age 18 and over, by race/ethnicity, United States, 2008

12_3_6.3 Admissions with stage III or IV pressure ulcers per 1,000 medical and surgical admissions with a length of stay of 5 or more days, age 18 and over, by income, United States, 2000-2008

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) disparities analysis file, and AHRQ Quality Indicators, modified version 4.1.

National Denominator

All medical and surgical hospital discharges, age 18 and over, with length of stay of 5 or more days, excluding patients in major diagnostic category (MDC) 9 (skin, subcutaneous tissue, and breast); patients with hemiplegia, paraplegia, or quadriplegia, spina bifida or anoxic brain damage, or debridement of pedicle graft before major procedure; transfers from other institutions; or obstetric admissions.

National Numerator

Subset of the denominator with any secondary diagnosis of decubitus ulcer.

Comments

The AHRQ PSI software requires that the pressure ulcer be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. Consistent with the AHRQ PSI software, the following cases are excluded: transfers from other institutions; admissions from long-term care facilities; admissions with diseases of the skin, subcutaneous tissue, or breast; admissions for hemiplegia, paraplegia, quadriplegia, spina bifida, or anoxic brain damage; and admissions in which debridement of pedicle graft is the only operating room procedure.

Rates are adjusted by age, comorbidities, MDC, and diagnosis-related group (DRG). When reporting is by age, the adjustment is by comorbidities, MDC, and DRG. The AHRQ PSI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).

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Other Complications of Hospital Care

Measure Title

Transfusion reactions.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

12_3_7.2_1 Admissions for transfusion reactions per 100,000 population, age 18 and over, United States, 2000, 2004, 2005, 2007, and 2008

12_3_7.2_2 Admissions for transfusion reactions per 100,000 population, age 18 and over, by race/ethnicity, United States, 2008

12_3_7.2_3 Admissions for transfusion reactions per 100,000 population, age 18 and over, by income, United States, 2000-2008

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) disparities analysis file, and AHRQ Quality Indicators, modified version 4.1.

National Denominator

U.S. population age 18 and over.

National Numerator

Subset of the denominator with a principal or secondary diagnosis indicating a transfusion reaction.

Comments

Rates are adjusted by age and gender using the total U.S. resident population for 2000 as the U.S. standard population; when reporting is by age, the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.

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Other Complications of Hospital Care

Measure Title

Deaths per 1,000 discharges with complications potentially resulting from care (failure to rescue).

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

12_3_8.1 Deaths per 1,000 elective-surgery admissions having developed specified complications of care during hospitalization, ages 18-89 or obstetric admissions, United States, 2000, 2004, 2005, 2007, and 2008

12_3_8.2 Deaths per 1,000 elective-surgery admissions having developed specified complications of care during hospitalization, ages 18-89 or obstetric admissions, by race/ethnicity, United States, 2008

12_3_8.4 Deaths per 1,000 elective-surgery admissions having developed specified complications of care during hospitalization, ages 18-89, by income, United States, 2000-2008

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1.

National Denominator

Hospital inpatient discharges, ages 18-89 years, with potential complications of care, excluding patients transferred in or out or patients admitted from long-term-care facilities.

National Numerator

Subset of the denominator with discharge disposition indicating death.

State Table

12_3_8.3 Deaths per 1,000 elective-surgery discharges having developed specified complications of care during hospitalization, ages 18-89 or obstetric admissions, by State, United States, 2000, 2004, 2007, and 2008

State Data Source

AHRQ, CDOM, HCUP, State Inpatient Databases (SID).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Potential complications of care include pneumonia, deep vein thrombosis/pulmonary embolism, sepsis, acute renal failure, shock/cardiac arrest, and gastrointestinal hemorrhage/acute ulcer.

Consistent with the AHRQ PSI software, complications of care include acute renal failure, pneumonia, pulmonary embolism, deep vein thrombosis, sepsis, shock, cardiac arrest, gastrointestinal hemorrhage, and acute ulcer with transfers to another hospital excluded. The AHRQ PSI software requires that the complication be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. In addition, the surgery is not verifiable as occurring in the first 2 days of the inpatient stay.

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Other Complications of Hospital Care

Measure Title

Deaths per 1,000 discharges in low-mortality diagnosis-related groups (DRGs).

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

12_3_9.1 Deaths per 1,000 hospital admissions with expected low mortality, age 18 and over or obstetric admissions, United States, 2000, 2004, 2005, 2007, and 2008

12_3_9.2 Deaths per 1,000 hospital admissions with expected low mortality, age 18 and over or obstetric admissions, by race/ethnicity, United States, 2008

12_3_9.4 Deaths per 1,000 hospital admissions with expected low mortality, age 18 and over or obstetric admissions, by income, United States, 2000-2008

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1.

National Denominator

Hospital admissions among people age 18 and over or obstetric conditions, in low-mortality DRGs (defined as DRGs with less than a 0.5% mortality rate), excluding patients with trauma, immunocompromised state, or cancer.

National Numerator

Subset of the denominator with discharge disposition indicating death.

State Table

12_3_9.3 Deaths per 1,000 hospital admissions with expected low mortality, age 18 and over or obstetric admissions, by State, United States, 2000, 2004, 2007, and 2008

State Data Source

AHRQ, CDOM, HCUP, State Inpatient Databases (SID).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Consistent with the AHRQ PSI software, admissions with expected low mortality are identified by Medicare Severity DRG or DRG, depending on the date of discharge. Exclusions include admissions with cancer, admissions in an immunocompromised state, and admissions involving a traumatic injury. Low-mortality DRGs are defined as DRGs with less than a 0.5% mortality rate, such as cesarean section without complications, major male pelvic procedures, and syncope and collapse.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, DRG, and transfers to the hospital. When reporting is by age, the adjustment is by gender, comorbidities, DRG, and transfers to the hospital; when reporting is by gender, the adjustment is by age, comorbidities, DRG, and transfers to the hospital. The AHRQ PSI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).

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Other Complications of Hospital Care

Measure Title

Patients with hospital-acquired pressure ulcers.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

12_3_10.1 Patients with hospital-acquired pressure ulcers, United States, 2004-2009

National Data Source

CMS, MPSMS.

National Denominator

All Medicare fee-for-service (FFS) discharges in the MPSMS sample.

National Numerator

Subset of the denominator who develop a pressure ulcer.

Comments

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Other Complications of Hospital Care

Measure Title

Deaths per 1,000 hospital admissions with pneumonia as principal diagnosis.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

This measure not reported in the 2011 NHQR and NHDR.

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators.

National Denominator

All discharges age 18 and over with principal diagnosis code of pneumonia, excluding patients transferred to another short-term hospital and obstetric and neonatal admissions.

National Numerator

Subset of the denominator who died.

Comments

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Complications of Medication

Measure Title

Hospital patients with an anticoagulant-related adverse drug event with warfarin.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

12_4_2.1 Hospital patients with an anticoagulant-related adverse drug event with warfarin, United States, 2004-2007 and 2009

National Data Source

CMS, MPSMS.

National Denominator

All Medicare fee-for-service (FFS) discharges from the MPSMS sample who received warfarin during hospitalization and had a documented international normalized ratio (INR) result during the hospital stay.

National Numerator

Subset of the denominator who during the hospital stay experienced:

INR ≥4.0 with one or more of the following: cardiac arrest/emergency measures to sustain life, death, gastrointestinal bleeding, genitourinary bleeding, hematocrit drop of 3 or more points more than 48 hours after admission, intracranial bleeding (subdural hematoma), new hematoma, other types of bleeding, or pulmonary bleeding.
INR >1.5 and an abrupt cessation/hold of warfarin with one or more of the above symptoms.
INR >1.5 and administration of vitamin K or fresh frozen plasma with one or more of the above symptoms.
INR >1.5 and a blood transfusion absent a surgical procedure with one or more of the above symptoms.

Comments

INRs ≥4.0, INRs > 1.5, and an abrupt cessation/hold of warfarin, INRs > 1.5 and administration of Vitamin K or fresh frozen plasma, and INRs > 1.5 and a blood transfusion (absent a surgical procedure) that occur the date of arrival are not counted.

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Complications of Medication

Measure Title

Hospital patients with an anticoagulant-related adverse drug event with IV heparin.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

12_4_3.1 Hospital patients with an anticoagulant-related adverse drug event with IV heparin, United States, 2004-2007 and 2009

National Data Source

CMS, MPSMS.

National Denominator

All Medicare fee-for-service (FFS) discharges from the MPSMS sample who received heparin during hospitalization and had a documented partial thromboplastin time (PTT) result during the hospital stay.

National Numerator

Subset of the denominator who experienced:

PTT ≥100 with one or more of the following: cardiac arrest/emergency measures to sustain life, death, gastrointestinal bleeding, genitourinary bleeding, hematocrit drop of 3 or more points more than 48 hours after admission, intracranial bleeding (subdural hematoma), new hematoma, other types of bleeding, or pulmonary bleeding.
PTT >45 and an abrupt cessation/hold of IV heparin with one or more of the above symptoms.
PTT >45 and administration of vitamin K or fresh frozen plasma with one or more of the above symptoms.
PTT >45 and a blood transfusion (absent a surgical procedure) with one or more of the above symptoms.

Comments

PTTs ≥100, PTTs >45, and an abrupt cessation/hold of warfarin, PTTs >45 and administration of Vitamin K or fresh frozen plasma, and PTTs >45 and a blood transfusion (absent a surgical procedure) that occur the date of arrival are not counted.

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Complications of Medication

Measure Title

Hospital patients with an anticoagulant-related adverse drug event with low-molecular-weight heparin (LMWH) or factor Xa.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

12_4_4.1 Hospital patients with an anticoagulant-related adverse drug event with low-molecular-weight heparin or factor Xa, United States, 2004-2007 and 2009

National Data Source

CMS, MPSMS.

National Denominator

All Medicare fee-for-service (FFS) discharges from the MPSMS sample who received LMWH or factor Xa during the hospital stay.

National Numerator

Subset of the denominator who experienced:

Abrupt cessation/hold of LMWH or factor Xa with one of the following: cardiac arrest/emergency measures to sustain life, death, gastrointestinal bleeding, genitourinary bleeding, hematocrit drop of 3 or more points more than 48 hours after admission, intracranial bleeding (subdural hematoma), new hematoma, other types of bleeding, or pulmonary bleeding.
Administration of vitamin K or fresh frozen plasma with one or more of the above symptoms.
Blood transfusion (absent a surgical procedure) with one or more of the above symptoms.

Comments

Abrupt cessation/holds of LMWH or factor Xa, administration of Vitamin K or fresh frozen plasma (FFP), and blood transfusions (absent a surgical procedure) that occur the date of arrival are not counted.

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Complications of Medication

Measure Title

Hospital patients with an adverse drug event with a hypoglycemic agent.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS)

National Table

12_4_5.1 Hospital patients with adverse drug events associated with hypoglycemic agents, including insulin, oral hypoglycemic, or combination of both, United States, 2004-2007 and 2009

National Data Source

CMS, MPSMS.

National Denominator

All Medicare fee-for-service (FFS) discharges from the MPSMS sample who received insulin, oral hypoglycemics, or both, and had a glucose result during the hospital stay.

National Numerator

Subset of the denominator who experienced a glucose level ≤70 with one or more of the following adverse events: administration of D50, administration of glucagons, administration of juice or sugar, anxiety, code blue (CPR), confusion, death, drowsiness, sweating, weakness, trembling, increased heart rate, irritability, seizure, stroke, transient ischemic attack, myocardial infarction, and coma/loss of consciousness.

Comments

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Other Complications

Measure Title

Ambulatory medical care visits due to adverse effects of medical care per 1,000 people.

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS).

National Tables

12_4_7.1 Visits to physician offices, hospital outpatient departments, and hospital emergency departments for adverse effects of medical care per 1,000 population, United States, 2006-2009

12_4_7.2a Visits to physician offices, hospital outpatient departments, and hospital emergency departments for adverse effects of medical care per 1,000 population, by race United States, 2008-2009

National Data Source

CDC, NCHS, NAMCS, NHAMCS.

National Denominator

U.S. civilian noninstitutionalized population.

National Numerator

Subset of the denominator with visits for treatment of adverse effects of medical or surgical care, or medicinal drugs.

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Page last reviewed October 2014

Internet Citation: Patient Safety: 2011 National Healthcare Quality and Disparities Reports. October 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/research/findings/nhqrdr/nhqrdr11/measurespec/patient_safety.html