Patient Safety Indicators Overview

What are Patient Safety Indicators?

The Patient Safety Indicators (PSIs) are a set of indicators providing information on potential in hospital complications and adverse events following surgeries, procedures, and childbirth. The PSIs were developed after a comprehensive literature review, analysis of ICD-9-CM codes, review by a clinician panel, implementation of risk adjustment, and empirical analyses.

How are Patient Safety Indicators used?

The PSIs can be used to help hospitals identify potential adverse events that might need further study; provide the opportunity to assess the incidence of adverse events and in hospital complications using administrative data found in the typical discharge record; include indicators for complications occurring in hospital that may represent patient safety events; and, indicators also have area level analogs designed to detect patient safety events on a regional level.

For more information about the Patient Safety Indicators, download the Patient Safety Indicators Brochure.

Patient Safety Indicators Resources

Technical Specifications

  • Individual Measure Technical Specifications (ICD 9 only version) — Provides a breakdown of the calculations used to formulate each PSI; each technical specification document includes a brief description of the measure, numerator information, denominator information and details on cases that should be excluded from calculations.

  • DRAFT Individual Measure Technical Specifications (Includes ICD 10 coding) — Provides a breakdown of the calculations used to formulate each PSI; each technical specification document includes a brief description of the measure, numerator information, denominator information and details on cases that should be excluded from calculations.

  • Log of Coding Updates and Revisions — Provides tables summarizing the revisions made to the PSI software, software documentation, and the technical specification documents since the original release of these documents in June 2002; the tables also reflect changes to indicator specifications based on updates to ICD-9-CM and MS-DRG codes through Fiscal Year 2013 (effective October 1, 2012) and incorporate coding updates that were implemented in both versions of the PSI software (SAS and Windows).

  • Parameter Estimates — Provides tables of PSI covariates and coefficients for risk adjustment logistic regression modelsProvides tables of PSI covariates and coefficients for risk adjustment logistic regression models.

  • Benchmark Data Tables — Provides tables of nationwide comparative rates for the PSI, including observed rate, numerator, and denominator data for each indicator overall and stratified by sex, age group, and insurance status.

Additional PSI Resources

  • PSI 90 Fact Sheet — The Patient Safety and Adverse Events Composite for the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) v6.0, 2016), is an updated and modified version of the Patient Safety Indicator for Selected Indicators Composite (v5.0 and prior). Highlights of the changes in the modified version include:
    • Addition of three Patient Safety Indicators (PSIs) to the composite including PSIs 09 (Perioperative Hemorrhage or Hematoma Rate), PSI 10 (Postoperative Acute Kidney Injury Rate), and PSI 11 (Postoperative Respiratory Failure Rate) and removal of PSI 07 (Central Venous Catheter-Related Blood Stream Infection Rate).
    • Refinement to three PSIs, including PSI 08 (In-Hospital Fall with Hip Fracture Rate), PSI 12 (Perioperative Pulmonary Embolism and Deep Vein Thrombosis Rate) and PSI 15 (Unrecognized Abdominopelvic Accidental Puncture or Laceration Rate)
    • Updated reference population using the 2013 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases from 36 participating states that provide complete “present on admission” information
    • Modified composite weighting approach to include both volume and harms of associated with an adverse event.
  • AHRQ Composite Measures Workgroup — Summarizes the work of the PSI Composite Measure Workgroup, which was convened to assist AHRQ in developing a composite measure based on the Patient Safety Indicators. For more information on Composite Workgroups, visit the AHRQ QI Composite Workgroups page.

  • AHRQ PSI Development — provides information on how the PSI measure set was developed.

Quality Indicator Software

Visit the AHRQ QI Software Page for more information on the Quality Indicators SAS 5.0 and WinQI software.