• Patient safety;
  • quality;
  • trends, outcomes, national


Emphasis has been placed on quality and patient safety in medicine; however, little is known about whether quality over time has actually improved in areas such as patient safety indicators (PSIs).


To determine whether national trends for hospital PSIs have improved from 1998 to 2007.

Design, Setting, and Participants

Using PSI criteria from the Agency for Healthcare Research and Quality, PSIs were identified in the Nationwide Inpatient Sample (NIS) for all eligible inpatient admissions between 1998 and 2007. Joinpoint regression was used to estimate annual percentage changes (APCs) for PSIs.

Main Outcome Measure

Annual percent change for PSIs.


From 1998 to 2007, 7.6 million PSI events occurred for over 69 million hospitalizations. A total of 14 PSIs showed statistically significant trends. Seven PSIs had increasing APC: postoperative pulmonary embolism or deep vein thrombosis (8.94), postoperative physiological or metabolic derangement (7.67), postoperative sepsis (7.17), selected infections due to medical care (4.05), decubitus ulcer (3.05), accidental puncture or laceration (2.64), and postoperative respiratory failure (1.46). Seven PSIs showed decreasing APCs: birth trauma injury to neonate (−17.79), failure to rescue (−6.05), postoperative hip fracture (−5.86), obstetric trauma–vaginal without instrument (−5.69), obstetric trauma–vaginal with instrument (−4.11), iatrogenic pneumothorax (−2.5), and postoperative wound dehiscence (−1.8).


This is the first study to establish national trends of PSIs during the past decade indicating areas for potential quality improvement prioritization. While many factors influence these trends, the results indicate opportunities for either emulation or elimination of current patient safety trends.