Validity of 16 AHRQ Patient Safety Indicators to identify in-hospital complications: A medical record review across nine Swiss hospitals.

Havranek, Michael M; Rüter, Florian; Bilger, Selina; Dahlem, Yuliya; Oliveira, Leonel; Ehbrecht, Daniela; Moos, Rudolf M; Westerhoff, Christian; Beck, Thomas; Le Pogam, Marie-Annick (2023). Validity of 16 AHRQ Patient Safety Indicators to identify in-hospital complications: A medical record review across nine Swiss hospitals. International journal for quality in health care, 35(4) Oxford University Press 10.1093/intqhc/mzad092

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BACKGROUND

The validity of the Agency for Healthcare Research and Quality's (AHRQ) Patient Safety Indicators (PSIs) has been established in the US and Canada. However, these indicators are also used for hospital benchmarking and cross-country comparisons in other nations with different healthcare settings and coding systems as well as missing present on admission (POA) flags in the administrative data. This study sought to comprehensively assess and compare the validity of 16 PSIs in Switzerland, where they have not been previously applied.

METHODS

We performed a medical record review using administrative and electronic medical record data from nine Swiss hospitals. Seven independent reviewers evaluated 1,245 cases at the various hospitals using retrospective data from the years 2014-2018. True positives, false positives, positive predictive values (PPVs), and reasons of misclassification were compared across all investigated PSIs, and the documentation quality of the PSIs was examined.

RESULTS

PSIs 6 (iatrogenic pneumothorax), 10 (postoperative acute kidney injury), 11 (postoperative respiratory failure), 13 (postoperative sepsis), 14 (wound dehiscence), 17 (birth trauma), as well as 18 and 19 (obstetric trauma with or without instrument) showed high PPVs (range: 90 to 99%) and were not strongly influenced by missing POA information. In contrast, PSIs 3 (pressure ulcer), 5 (retained surgical item), 7 (central venous catheter-related bloodstream infection), 8 (fall with hip fracture), and 15 (accidental puncture/laceration) showed low PPVs (range: 18 to 49%). In the case of PSIs 3, 8, and 12 (perioperative embolism/thrombosis), the low PPVs were largely due to the lack of POA information. Additionally, it was found that the documentation of PSI 3 in discharge letters could be improved.

CONCLUSION

We found large differences in validity across the 16 PSIs in Switzerland. These results can guide policymakers in Switerzland and comparable healthcare systems in selecting and prioritizing suitable PSIs for quality initiatives. Furthermore, the national introduction of a POA flag would allow for the inclusion of additional PSIs in quality monitoring.

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