• Shivang Bhakta, Benjamin D Pollock, Young M Erben, Michael A Edwards, Katherine H Noe, Sean C Dowdy, Moreno FrancoPabloP0000-0001-9146-5599Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA.Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA.Department of Qualit, and Jennifer B Cowart.
• Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA.
• J Hosp Med. 2022 May 1; 17 (5): 350-357.

BackgroundPatient 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.ObjectiveWe sought to compare the cumulative incidence of PSI-12 in patients with and without acute COVID-19 infection.Design, Setting, And ParticipantsThis 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 MeasuresWe 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.ResultsOur 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.ConclusionPatients 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.© 2022 Society of Hospital Medicine.

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