Is Patient Safety Improving?

National Trends in Patient Safety Indicators: 1998-2007

Over the past decade, significant emphasis has been placed on patient safety. New measures and systems have emerged to measure safety and quality, yet little is known about their effectiveness. This article assesses patient safety indicators (PSIs) over the past decade to examine whether national trends have improved.

This study uses data from the Nationwide Inpatient Sample (NIS) on eligible inpatient admissions between 1998 and 2007. The NIS data includes de-identified discharge data (up to 15 diagnoses and procedures) from 1,045 hospitals located in 38 states. PSI criteria were from the Agency for Healthcare Research and Quality. Annual percent changes for PSIs were estimated using joinpoint regression.

Key Findings:

  • Of the 15 PSIs considered in this study, seven PSIs had increasing annual percentage changes, including postoperative pulmonary embolism or deep vein thrombosis, postoperative physiological or metabolic derangement, postoperative sepsis, selected infections due to medical care, decubitus ulcer, accidental puncture or laceration, and postoperative respiratory failure.
  • Seven PSIs had decreasing annual percentage changes, including birth trauma injury to neonate, failure to rescue, postoperative hip fracture, obstetric trauma-vaginal without instrument, obstetric trauma-vaginal with instrument, iatrogenic pneumothorax, and postoperative wound dehiscence.
  • PSI rates fell from 454.01 per 1,000 patient admissions in 1998 to 353.15 in 2007.

This study provides important information in understanding national trends of PSIs and demonstrating possible priority areas for quality improvement.

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