Trends in Inpatient Patient Safety Indicators Before and After the Onset of the COVID-19 Pandemic in the United States: 2018 to 2022

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Abstract
Objectives: The COVID-19 pandemic challenged hospitals. Yet, little is known about the extent of COVID-19’s impact on patient safety. We assessed change in Patient Safety Indicators (PSIs), which identify potentially preventable adverse events, before and after the onset of COVID-19 and when a hospital had a high proportion of COVID-19 admissions. Methods: Using Medicare Provider Analysis and Review data, our sample included 51,960,029 non-COVID-19 admissions eligible for inclusion in at least 1 PSI. This included 23,262,714 patients and a total of 294,871 PSI events. We fit risk-adjusted trends from 2018 to 2022 using interrupted time series models of PSIs before and after the onset of COVID-19. We also tested for the difference of a hospital having a high proportion of COVID-19 admissions. PSIs were categorized into provider-resource, surgical/team-resource, or hospital-resource-dependent events. Results: Ten (of 14) PSIs were worse after the onset of COVID-19 and had substantial increases in event rates, ranging from 14.6% (postoperative sepsis) to 51.9% (central venous catheter-related bloodstream infections). Also, when a hospital had a high proportion of COVID-19 admissions, 8 PSIs significantly worsened and had substantial increases in event rates, ranging from 5.9% (postoperative pulmonary embolism/deep venous thrombosis) to 15.8% (postoperative sepsis). Conclusion: The COVID-19 pandemic placed immense, prolonged strain on hospitals, resulting in a worsening of inpatient patient safety events. Increased rates of safety events occurred whether events were provider-resource, surgical/team-resource, or hospital-resource-dependent. These findings are a call for hospitals to return to placing heightened emphasis on reducing preventable harm and minimizing hospital complications and adverse events.

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