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Harborview Medical Center in Seattle, Washington, has improved patient safety across its facilities using AHRQ’s Quality Indicators (QIs) — standardized measures used to assess and monitor healthcare quality. A level 1 trauma center and safety net hospital, Harborview uses QIs to review adverse events and integrate new, safer processes into standard care. Since adopting QIs in 2011, the hospital has reduced the percentage of potentially preventable blood clots after surgery. Using QIs has also improved Harborview’s Patient Safety and Adverse Events Composite rating (). 

Harborview started working with QIs nearly 15 years ago at the direction of hospital leaders. According to clinical quality analyst Ellen Robinson, P.T., who oversees Harborview’s QI efforts, “The new medical director for the hospital had just been promoted from director of quality, so patient safety was a priority. I was tasked with figuring out Patient Safety Indicators (PSIs), which had recently been added to patient safety scorecards.” 

PSIs are a subset of QIs that focus on in-hospital safety issues, specifically for adverse events that were not present during patient admission. Information on cases is shared with clinicians for review and feedback and can be used to improve hospital practices.

With Harborview’s PSI reporting and review process well-established, the hospital uses PSI modules across its medical, surgery, inpatient rehabilitation, and behavioral health areas. The latter two areas are primarily concerned with PSIs for pressure ulcers and falls. The bulk of the PSI efforts are geared toward evaluating and addressing patient safety in Harborview’s medical/surgery areas. 

“Because we're a trauma center, our highest level of PSI was for venous thromboembolism (VTE), or blood clots, so we started by looking at those,” Robinson said. After running the data, she and her team realized that the reports weren’t capturing all VTEs because PSIs have some exclusions for neurological trauma. They tailored their system to report on all blood clots that occurred at the hospital. 

Robinson noted, “Harborview has a very robust interdisciplinary team that evaluates hospital-acquired VTEs. This team reviews every VTE case each month to determine that all patients received guideline-directed prophylaxis; for example, the patient received the right drug at the right dose every day prior to the VTE.”  Systematic improvements made from PSI case reviews have improved compliance with daily guideline-directed VTE prophylaxis from 80 to 95 percent.

The hospital follows a similar process for other types of PSIs as well. “We now have an established process and the right experts in place to quickly detect and review safety issues and implement safer practices related to all PSIs,” Robinson said. 

The hospital has made great strides in improving patient safety as indicated by its improved PSI 90 scores. PSI 90 scores below 1.0 indicate better-than-average performance; Harborview’s score went from 1.21 in 2014 to 0.953 in 2024. The staff remain focused on making care as safe as possible at the hospital’s facilities using the PSIs as a guide.