The association of acute COVID‐19 infection with Patient Safety Indicator‐12 events in a multisite healthcare system

Abstract

Background Patient Safety Indicator (PSI)‐12, a hospital quality measure designed by Agency for Healthcare Research and Quality (AHRQ) to capture potentially preventable adverse events, captures perioperative venous thromboembolism (VTE). It is unclear how COVID‐19 has affected PSI‐12 performance. Objective We sought to compare the cumulative incidence of PSI‐12 in patients with and without acute COVID‐19 infection. Design, Setting, and Participants This was a retrospective cohort study including PSI‐12‐eligible events at three Mayo Clinic medical centers (4/1/2020‐10/5/2021). Exposure, Main Outcomes, and Measures We compared the unadjusted rate and adjusted risk ratio (aRR) for PSI‐12 events among patients with and without COVID‐19 infection using Fisher's exact χ2 test and the AHRQ risk‐adjustment software, respectively. We summarized the clinical outcomes of COVID‐19 patients with a PSI‐12 event. Results Our cohort included 50,400 consecutive hospitalizations. Rates of PSI‐12 events were significantly higher among patients with acute COVID‐19 infection (8/257 [3.11%; 95% confidence interval {CI}, 1.35%–6.04%]) compared to patients without COVID‐19 (210/50,143 [0.42%; 95% CI, 0.36%–0.48%]) with a PSI‐12 event during the encounter (p < .001). The risk‐adjusted rate of PSI‐12 was significantly higher in patients with acute COVID‐19 infection (1.50% vs. 0.38%; aRR, 3.90; 95% CI, 2.12–7.17; p < .001). All COVID‐19 patients with PSI‐12 events had severe disease and 4 died. The most common procedure was tracheostomy (75%); the mean (SD) days from surgical procedure to VTE were 0.12 (7.32) days. Conclusion Patients with acute COVID‐19 infection are at higher risk for PSI‐12. The present definition of PSI‐12 does not account for COVID‐19. This may impact hospitals' quality performance if COVID‐19 infection is not accounted for by exclusion or risk adjustment.

Impact of Collaborative Nursing Care Delivery on Patient Safety Events in an Emergency Intensive Care Unit: A Retrospective Observational Study

“…This study included patients who were admitted to our facility between April 1, 2019, and March 31, 2021, and received nursing care under a single NCDS. Pediatric patients and those with coronavirus disease 2019 (COVID-19) were excluded from the study given that their patient factors and management methods differ from those of other patients 23–25 . Furthermore, patients who left the EICU within 24 hours of admission or those who declined to participate were also excluded.…”

“…The nurse-to-patient ratio (NPR) was calculated by dividing the number of patients admitted during one shift by the number of nurses working that shift. We also calculated the NPR that excluded COVID-19 patients and their charge nurses, because of COVID-19 patients, who were at high risk of PSEs and atypically staffed 23 . Bed occupancy rate was calculated using the following formula: (total number of inpatient days in a period × 100) / (number of available beds × number of days in a period).…”

“…Pediatric patients and those with coronavirus disease 2019 (COVID-19) were excluded from the study given that their patient factors and management methods differ from those of other patients. [23][24][25] Furthermore, patients who left the EICU within 24 hours of admission or those who declined to participate were also excluded. The group of patients admitted from April 1, 2019, to March 31, 2020, were considered preintervention and the group of patients admitted from April 1, 2020, to March 31, 2021, were considered postintervention.…”

“…We also calculated the NPR that excluded COVID-19 patients and their charge nurses, because of COVID-19 patients, who were at high risk of PSEs and atypically staffed. 23 Bed occupancy rate was calculated using the following formula: (total number of inpatient days in a period  100) / (number of available beds  number of days in a period). The BOR for beds other than COVID-19 beds was also calculated using the above formula without including COVID-19 patients and the number of beds dedicated to COVID-19.…”