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Increased Risk and Unique Clinical Course of Patient Safety Indicator-3 Pressure Injuries Among COVID-19 Hospitalized
Jennifer B Cowart, Jorge Sinclair De Frías1, Benjamin D Pollock
1Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida.
Insights
COVID-19 infection significantly increased patient safety indicator (PSI-3) events in hospitalized patients. Healthcare quality metrics may need updates to account for the pandemic's impact on patient safety.
Area of Science:
- Healthcare quality and patient safety research.
- Infectious disease epidemiology.
- Hospital administration and patient outcomes.
Background:
- The COVID-19 pandemic presented unprecedented challenges to healthcare systems globally.
- Patient safety during hospitalization became a critical concern, with limited understanding of COVID-19's specific impact on adverse events.
- Patient Safety Indicators (PSIs) are crucial for monitoring healthcare quality, but their relationship with COVID-19 required investigation.
Purpose of the Study:
- To determine the association between COVID-19 infection and Patient Safety Indicator-3 (PSI-3) event rates.
- To compare PSI-3 event rates in COVID-19-infected versus uninfected patient cohorts.
- To analyze the clinical characteristics of COVID-19 patients who experienced PSI-3 events.
Main Methods:
- Retrospective analysis of 126,781 hospital encounters at Mayo Clinic from January 2020 to February 2022.
- Patients were stratified based on acute COVID-19 infection status.
- Patient Safety Indicator-3 (PSI-3) events were identified using AHRQ WinQI software, with comparative analysis of demographics, clinical characteristics, and event rates.
Main Results:
- COVID-19-infected patients (6.8% of cohort) exhibited significantly higher PSI-3 rates (0.21% vs. 0.06%, P < 0.0001) compared to uninfected patients, even after risk adjustment (adjusted risk ratio, 3.24).
- COVID-19 patients experiencing PSI-3 events were older, more likely male, non-white, and had private insurance.
- A case series of 17 COVID-19 patients revealed specific patterns, including increased medical device-related pressure injuries, particularly on the head, face, and neck.
Conclusions:
- Acute COVID-19 infection is independently associated with an elevated risk of Patient Safety Indicator-3 (PSI-3) events.
- Existing healthcare quality metrics may not fully capture the complexities introduced by the COVID-19 pandemic.
- Further research is essential to understand the nuanced relationship between COVID-19 and patient safety outcomes to inform future healthcare practices.
Background:
The COVID-19 pandemic introduced unique challenges to healthcare systems, particularly in relation to patient safety and adverse events during hospitalization. There is limited understanding of COVID-19's association with some patient safety indicators (PSIs).
Objectives:
This study aimed to investigate the impact of COVID-19 infection on the rate of PSI-3 events and its implications on quality metrics. We compared PSI-3 event rates between COVID-19-infected and uninfected patients and examined the clinical characteristics of COVID-19 patients experiencing PSI-3 events.
Methods:
This is a retrospective study at Mayo Clinic hospitals between January 2020 and February 2022, analyzing patients meeting PSI-3 denominator eligibility criteria. PSI-3 events were identified using AHRQ WinQI software. Patients were categorized based on COVID-19 status. Patient demographics, characteristics, and PSI-3 rates were compared. A case series analysis described clinical details of COVID-19 patients with PSI-3 events.
Results:
Of 126,781 encounters meeting PSI-3 criteria, 8674 (6.8%) had acute COVID-19 infection. COVID-19-infected patients were older, more likely to be male, non-white, and had private insurance. PSI-3 rates were significantly higher in COVID-19 patients (0.21% versus 0.06%, P < 0.0001), even after risk adjustment (adjusted risk ratio, 3.24, P < 0.0001). The case series of 17 COVID-19 patients with PSI-3 events showed distinctive clinical characteristics, including higher medical device-related pressure injuries, and greater predisposition for head, face, and neck region.
Conclusions:
Acute COVID-19 infection correlates with higher PSI-3 event rates. Current quality indicators may require adaptation to address the pandemic's complexities and impact on patient safety. Further research is needed to comprehensively understand the intricate relationship between COVID-19 and patient outcomes.
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