The reporting practice that could lead to unreliable patient safety data

Some hospitals may classify admissions in a way that exempts them from elective-based patient safety indicator scores, or PSIs, leading to less reliable patient safety data, according to a study published in the August issue of The Joint Commission Journal on Quality and Patient Safety.

Hospitals classify admissions as elective or non-elective based on internal definitions. Researchers hypothesized these internal admission classification policies may lead to some hospitals being exempt from elective-based PSIs. 


Researchers from Chicago-based Rush University Medical center analyzed inpatient Medicare claims data from 3,484 hospitals during the PSI measurement period from 2015 to 2017. They measured the average percentage of elective admissions, known as APE, across surgical diagnosis-related groups, or DRGs. Using multiple regression and machine learning, they compared this data to hospital characteristics, surgical claims volumes, and numbers and types of surgical DRGs.

For 96 of the hospitals, researchers found exceptionally low APE could not be explained by surgical claims volume, surgical DRGs among claims or hospital characteristics. "These outliers were disproportionately exempt from elective-based PSI scores," the study said. 

"Transparency into admission classification policies is needed to ensure fair and reliable use of PSIs when ranking hospitals and adjusting payments," researchers concluded. "Alternatively, PSIs may need modifications to rely on externally validated criteria." 

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