Skip to main content

Patient Safety Indicator (PSI) 90: Patient Safety and Adverse Events Composite

CBE ID
0531
Endorsement Status
1.0 New or Maintenance
Previous Endorsement Cycle
Is Under Review
Yes
Next Maintenance Cycle
Fall 2024
1.6 Measure Description

PSI 90 is a composite of ten adverse event indicators that summarizes hospitals’ performance on patient safety for the CMS Medicare fee-for-service population. The timeframe used in the CMS Hospital Acquired Conditions Reduction Program (HACRP) and CareCompare public reporting are set within the Inpatient Prospective Payment Systems (IPPS) Final Rule annually. Typically, the performance periods use multiple months of claims data.

Measure Specs
General Information
1.7 Measure Type
1.7 Composite Measure
Yes
1.3 Electronic Clinical Quality Measure (eCQM)
1.8 Level of Analysis
1.10 Measure Rationale

The Patient Safety Indicator (PSI) 90 composite measure captures hospital performance related to the occurrence of 10 preventable adverse events among hospitalized patients. The ten risk-adjusted PSIs that comprise PSI 90 are listed below.

  • PSI 03 Pressure Ulcer Rate
  • PSI 06 Iatrogenic Pneumothorax Rate
  • PSI 08 In-Hospital Fall-Associated Fracture Rate
  • PSI 09 Postoperative Hemorrhage or Hematoma Rate
  • PSI 10 Postoperative Acute Kidney Injury Requiring Dialysis Rate
  • PSI 11 Postoperative Respiratory Failure Rate
  • PSI 12 Perioperative Pulmonary Embolism or Deep Vein Thrombosis Rate
  • PSI 13 Postoperative Sepsis Rate
  • PSI 14 Postoperative Wound Dehiscence Rate
  • PSI 15 Abdominopelvic Accidental Puncture or Laceration Rate. 

The rationale for reporting this measure is three-fold: (1) to encourage hospitals to implement best practices to minimize adverse events, (2) to help patients understand hospitals’ quality of care and make selection decisions, and (3) to allow payers to track hospital performance.  PSI 90 is implemented in CMS’s Hospital Acquired Condition Reduction Program (HACRP). This program evaluates hospitals’ performance on patient safety measures and reduces Medicare payments for hospitals that perform poorly. Given the measure’s results impact payment, hospitals are motivated to implement safe hospital practices that minimize risks of harmful patient outcomes and improve care quality. 

PSI 90 results are also publicly posted on https://www.medicare.gov/care-compare/?providerType=Hospital  for CMS and Veteran Affair (VA) hospitals. Prospective patients can use these scores to evaluate hospitals’ quality performance as it relates to patient safety and use this information to make informed decisions regarding where they seek care.

1.20 Types of Data Sources
1.25 Data Source Details

CMS calculates PSI 90 using claims data from Medicare fee-for-service (FFS) discharges, using final action claims for inpatient stays paid under the Inpatient Prospective Payment System (IPPS).