Patient Safety Indicators — Agency for Healthcare Research and Quality

The Agency for Healthcare Research and Quality (AHRQ) is a federal agency for research on health care quality, costs, outcomes and patient safety.

AHRQ has created software that screens billing records for potentially preventable complications (adverse events) that patients sometimes experience while receiving medical care. Mayo Clinic tracks and analyzes these events, called patient safety indicators (PSIs), in an effort to prevent future occurrences.

The glossary below identifies the complications that are measured and defines them.

  • Accidental puncture or laceration. Accidental cut or wound during a procedure.
  • Central venous catheter–related bloodstream infections. An infection that enters the blood via a catheter placed into a major venous blood vessel.
  • Death in low-mortality Diagnosis-Related Groups (DRG). Death of a patient with a generally non-serious diagnosis or during a procedure that usually has a low number of deaths (mortality). Diagnosis-Related Groups is a patient classification system.
  • Death among surgical inpatients with treatable serious complications. Death of a patient who develops a treatable life-threatening complication after a surgical procedure.
  • Excessive bruising or bleeding as a consequence of a procedure. A large amount of bruising or bleeding because of a procedure.
  • Foreign object left in during procedure. Unplanned sponge or equipment left in wound during a procedure.
  • Iatrogenic pneumothorax. Lung collapse that occurs when air leaks into the area between the lungs and chest wall (pleural space). This is sometimes caused by accident during surgery or other procedures performed on the chest.
  • Postoperative hip fracture. Broken hip after surgery.
  • Postoperative physiologic and metabolic derangements. Electrolyte and fluid imbalance after surgery.
  • Postoperative respiratory failure. Breathing failure after surgery.
  • Postoperative pulmonary embolism or deep vein thrombosis. Deep blood clots in the lungs or legs after surgery.
  • Postoperative sepsis. Bloodstream infection after surgery.
  • Postoperative wound dehiscence. Reopening of a surgical incision or breakdown of an incision in the abdominal area.
  • Pressure ulcer. The breakdown of skin tissue, not present on hospital admission, caused by sitting or lying in the same position for a long period of time.