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Is Patient Safety Improving? National Trends in Patient Safety Indicators: 1998–2007
Author(s) -
Downey John R.,
HernandezBoussard Tina,
Banka Gaurav,
Morton John M.
Publication year - 2012
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/j.1475-6773.2011.01361.x
Subject(s) - medicine , patient safety , deep vein , accidental , emergency medicine , surgery , health care , thrombosis , physics , acoustics , economics , economic growth
Context Emphasis has been placed on quality and patient safety in medicine; however, little is known about whether quality over time has actually improved in areas such as p atient s afety i ndicators ( PSIs ). Objective To determine whether national trends for hospital PSIs have improved from 1998 to 2007. Design, Setting, and Participants Using PSI criteria from the Agency for Healthcare Research and Quality, PSIs were identified in the Nationwide Inpatient Sample ( NIS ) for all eligible inpatient admissions between 1998 and 2007. Joinpoint regression was used to estimate annual percentage changes ( APCs ) for PSIs . Main Outcome Measure Annual percent change for PSIs . Results From 1998 to 2007, 7.6 million PSI events occurred for over 69 million hospitalizations. A total of 14 PSI s showed statistically significant trends. Seven PSI s had increasing APC : postoperative pulmonary embolism or deep vein thrombosis (8.94), postoperative physiological or metabolic derangement (7.67), postoperative sepsis (7.17), selected infections due to medical care (4.05), decubitus ulcer (3.05), accidental puncture or laceration (2.64), and postoperative respiratory failure (1.46). Seven PSI s showed decreasing APCs : birth trauma injury to neonate (−17.79), failure to rescue (−6.05), postoperative hip fracture (−5.86), obstetric trauma–vaginal without instrument (−5.69), obstetric trauma–vaginal with instrument (−4.11), iatrogenic pneumothorax (−2.5), and postoperative wound dehiscence (−1.8). Conclusion This is the first study to establish national trends of PSI s during the past decade indicating areas for potential quality improvement prioritization. While many factors influence these trends, the results indicate opportunities for either emulation or elimination of current patient safety trends.