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Targeted Chart Review of Pediatric Patient Safety Events Identified by the Agency for Healthcare Research and Quality's Patient Safety Indicators Methodology

Objectives: We reviewed potential patient safety events identified with Agency for Healthcare Research and Quality's Patient Safety Indicator (PSI) Software to characterize clinical events associated with potential patient safety events and to identify clinical opportunities for care improvement. Methods: Agency for Healthcare Research and Quality's PSI algorithms (version 2.1, revision 1) were applied to the National Association of Children's Hospitals and Related Institutions Case Mix Database, and clinicians at 14 hospitals retrospectively reviewed 1151 events from 1132 patient charts identified as having potential patient safety events. Standard questions were asked for each PSI, and preventability of events was assessed. Results: Infection due to medical care was the most commonly confirmed potentially preventable patient safety event using the PSI software. Pediatric-specific findings were identified for PSIs related to decubitus ulcers, foreign bodies associated with procedures, and procedure-associated thrombosis. The primary diagnosis identified by medical coders agreed with clinician evaluation 92.2% of the time. The chart review confirmed previous work done with administrative data; the indicators complications of anesthesia, death in low-mortality diagnosis-related groups, and failure to rescue were inaccurate in the pediatric population. Significant variation in preventability was identified for the 11 PSIs. Conclusions: Clinician chart reviews to verify pediatric patient safety events suggest that 8 of 11 PSIs are useful for quality improvement in pediatric patients but are inadequate for public comparison of hospital performance. Infection caused by medical care was the most commonly preventable patient safety event. Targeted chart reviews using PSI software are a useful way to guide hospitals in prioritizing their patient safety efforts based on hospital-specific data about patient injury.