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Quality Definitions and Methodology

Surgical Complications

Higher rates of serious, but potentially preventable, complications may be a sign of poorer quality hospital care. Hospitals can reduce the chance of these serious complications by following safe practices.

This section shows serious complications that patients with Original Medicare experienced during a hospital stay, and how often patients who were admitted with certain conditions died while they were in the hospital. These complications and deaths can often be prevented if hospitals follow procedures based on best practices and scientific evidence.

The report is based on information from Medicare fee-for-service claims from short term, acute care hospitals and is not case-mix adjusted. Columns are defined as follows:

Measure
The name of the quality measure. Click column header for a pop-up with additional information about each.
Number Patients
The size of the data sample for the hospital quality measure.
Rate
The percentage of patients in the data sample for a measure that experienced the serious complication or death.
Predicted Range
A range of expected rates is calculated based on national statistics and risk-adjustment factors.
National Average
The average rate achieved by all hospitals in the nation for the quality measure.
. Complications for Hip/Knee Replacements
IQI-11. Death after surgery to repair a weakness in the abdominal aorta

Patients who died after being admitted to the hospital for surgery to repair an abdominal aortic aneurism (AAA), a weakness in the main artery that supplies blood to the belly and legs. Abdominal aortic aneurisms are serious conditions that can lead to death, if they aren’t repaired before they burst or start to leak blood. The surgery to repair AAA is complex. Higher death rates may be a sign that a hospital has less experienced surgical teams.

IQI-19. Deaths after admission for a broken hip

Patients who died after being admitted to the hospital for a broken hip (hip fracture). Many older people are admitted to the hospital because they've fallen and broken their hips. Because it's a common, serious problem for older people, hospitals should have procedures in place for safely treating patients with hip fractures, to prevent serious problems that can cause death. Some deaths may be unavoidable, but a hospital with a higher death rate for patients with hip fractures may not be using evidence-based procedures to treat patients with these conditions.

IQI-91. Deaths from Certain Conditions

(A composite of six measures)

Patients who were admitted to the hospital with certain conditions, who died while they were in the hospital. Many people are admitted to the hospital because of certain common, serious conditions. Hospitals should have procedures in place for treating these common conditions to prevent serious problems that can cause death. Some deaths may be unavoidable, but a hospital with a higher death rate for these conditions might not be using evidence-based procedures to treat patients with these conditions.

PSI-3. Pressure sores
PSI-4. Death from serious treatable complications after surgery

Surgical patients who died after developing serious complications that could have been treated. There's always a risk of serious complication during or after surgery. However, hospitals with trained, well organized, and efficient staff identify these complications quickly and treat them aggressively. Some deaths may be unavoidable. But higher death rates from complications may be a sign that patients weren't watched closely after surgery or that effective action wasn't taken.

PSI-6. Collapsed lung due to medical treatment

During certain medical procedures, there's a chance that the patient's lung will be accidentally punctured. This can cause air to escape and the lung to collapse. Usually, this complication is rare, and sometimes, it's unavoidable. However, if a hospital has a higher rate of this complication, it may be a sign that the hospital is giving poor quality care in this area.

PSI-7. Infections from a large venous catheter
PSI-8. Broken hip from a fall after surgery
PSI-9. Postoperative Hemorrhage or Hematoma Rate
PSI-10. Postoperative Acute Kidney Injury Rate
PSI-11. Postoperative Respiratory Failure Rate

Patients who were unable to breathe after surgery without the help of a ventilator (a machine that helps someone breathe). If patients have breathing problems after surgery, doctors usually order special treatment (respiratory therapy) to make sure they get enough oxygen into their bloodstream. Even so, some patients may not be able breathe on their own, especially if they were very frail or sick to begin with. However, if a hospital has a higher rate of breathing failure among its surgical patients, it may be a sign that it isn’t providing high-quality and effective care.

PSI-12. Serious blood clots after surgery

When patients stay still for a long time after some types of surgery, they're more likely to develop a serious blood clot in the veins of the legs, thighs, or pelvis. This is especially true for patients who are very frail or sick. A blood clot can also break off and travel to other parts of the body. If a blood clot gets into a patient's lung, it’s a serious problem that can cause death. Some patients may get blood clots even though doctors order treatments to prevent them. However, if a hospital has a higher rate of serious blood clots after surgery, it may be a sign that doctors and nurses aren’t doing enough to prevent them.

PSI-13. Blood stream infection after surgery
PSI-14. A wound that splits open after surgery

Surgical wounds may split open after surgery, even when the surgeon sewed the wound up correctly. This may happen when wounds aren't healing well, or because of problems like severe coughing or vomiting. If a hospital has a higher rate of this complication, it may be a sign that doctors and nurses aren’t paying close enough attention to their patients or providing proper care.

PSI-15. Accidental cuts and tears from medical treatment

During some complicated medical procedures, there’s a chance that a part of the patient’s body will be accidentally cut. Sometimes, it may be unavoidable. But if a hospital has a higher rate of this complication, it may be a sign that the medical staff aren’t using proper techniques when performing these procedures.

PSI-90. Serious Complications

(A composite of eight measures)

Higher rates of serious, but potentially preventable, complications may be a sign of poorer quality hospital care. Hospitals can reduce the chance of these serious complications by following safe practices.