Introduction: The Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services (CMS) hospital acquired conditions (HACs) are used to evaluate the safety and quality of healthcare provided by healthcare systems and individual facilities. To better understand the incidence of these events in hospitalized stroke patients, we determined the rates of PSIs and HACs among patients with a diagnosis of stroke in the Nationwide Inpatient Sample (NIS) database.
Methods: We queried the NIS for all hospitalizations involving ischemic stroke. We determined the incidence of various PSIs and HACs by searching the hospital records for ICD-9 codes indicating each PSI or HAC. Statistical analysis was performed with SAS.
Results: There were 903,647 hospitalizations involving stroke in the NIS database for years 2002-2010. Among these hospitalizations a total of 137,161 (15.2%) patients experienced one or more AHRQ PSI. The most common PSIs included postoperative respiratory failure (9.44%), sepsis (4.43%), and pressure ulcer (2.19%). A total of 28,323 (3.13%) of stroke patients experienced one or more HAC. The most common HACs included falls and trauma (2.51%) and stage III & IV pressure ulcers (0.43%). Increasing comorbidity score (p=0.001) was associated with increased likelihood of all PSIs and HACs. Presence of PSI or HAC resulted in increased length of stay, increased hospital charges and an increase in mortality rates (p<0.0001).
Conclusions: Our results estimate baseline national incidence rates of PSIs and HACs in stroke patients. These data may be used to determine individual institutional improvements or success by comparison.
Patient Care: These data establish baseline performance measures in hospitalized stroke patients as monitored by Medicare and insurance companies. This research highlights the importance of complication avoidance in neurosurgery patients and opens a discussion about how these measures may impact the practice of cerebrovascular neurosurgery.
Learning Objectives: By the conclusion of the session participants should be able to:
1) Understand the definition of patient safety indicator (PSI) and hospital acquired condition (HAC)
2) Discuss the general prevalence of common PSIs and HACs in hospitalized stroke patients
3) Understand the implications of these performance measures for the practice and reimbursement of neurosurgeons