Using administrative data to identify surgical adverse events: an introduction to the Patient Safety Indicators

The Patient Safety Indicators (PSIs) are algorithms based on the International Classification of Diseases, Ninth Revision, Clinical Modification, aimed at identifying potential safety-related adverse events through the automated screening of readily available administrative databases. Many of these indicators focus on surgical care, and a few have been endorsed by the National Quality Forum as performance measures. The aim of this report is to give a brief overview of the development and definitions of the PSIs as well as the current evidence for their validity, compared with the National Surgical Quality Improvement Program and chart abstraction designed for the purpose of PSI validation.

Several articles published in the past few years, in addition to primary data collected from an ongoing study of PSI validation in the Veterans Health Administration, were examined.

Selected surgical PSIs have positive predictive values ranging from 22% to 89%, depending on the nature of the PSI and the method of validation used.

With adequate coding revisions, PSI performance can be substantially improved.