Introduction

In the article published on April 22, 2024, on patient safety trends in 2023,1 reporting rates for 2023 were calculated based on Q1 and Q2 only, as denominator data for Q3 and Q4 were not yet available. This brief update provides the final rates for 2023 using all quarters of data, contrasting them with rates based on Q1 and Q2 only.

Methods

This analysis was performed using data extracted from the Pennsylvania Patient Safety Reporting System (PA-PSRS)[1] on July 16, 2024, and data obtained from the Pennsylvania Health Care Cost Containment Council (PHC4)[2] on July 1, 2024. Rates are calculated as the number of reports of events occurring in a given time frame per 1,000 patient days for hospitals and per 1,000 surgical encounters for ambulatory surgical facilities (ASFs). Since rates are based on the event occurrence date, and not submission date, some rates in this brief update are slightly different than previously published rates. This is due to reports for events that occurred in prior periods being submitted after the original data extraction dates.

Results

Figure 1 shows rates by year from 2014 through 2023. With the addition of Q3 and Q4 data, the final hospital rate for 2023 increased by 0.8 points from the rate using only Q1 and Q2. The 2023 hospital rate of 30.9 represents the first increase since 2019. For ASFs, the final rate for 2023 increased by 0.4 points from the rate using only Q1 and Q2. The 2023 ASF rate continued its consistent climb to 10.3. The bar charts in Figure 1 show rates for each of the four quarters of 2023 for hospitals and ASFs.

Figure 1. PA-PSRS Event Report Rates for Hospitals and ASFs From 2014 Through 2023.
Figure 1.PA-PSRS Event Report Rates for Hospitals and ASFs From 2014 Through 2023.

Note: Since rates are based on the event occurrence date, and not submission date, some rates may be slightly different than previously published. This is due to reports for events that occurred in prior periods being submitted after prior published results.

Note

This analysis was exempted from review by the Advarra Institutional Review Board.

Disclosure

The author declares that they have no relevant or material financial interests.

About the Author

Shawn Kepner (shawkepner@pa.gov) is a data scientist at the Patient Safety Authority.

  1. PA-PSRS is a secure, web-based system through which Pennsylvania hospitals, ambulatory surgical facilities, abortion facilities, and birthing centers submit reports of patient safety–related incidents and serious events in accordance with mandatory reporting laws outlined in the Medical Care Availability and Reduction of Error (MCARE) Act (Act 13 of 2002).2 All reports submitted through PA-PSRS are confidential and no information about individual facilities or providers is made public.

  2. The Pennsylvania Health Care Cost Containment Council (PHC4) is an independent state agency responsible for addressing the problem of escalating health costs, ensuring the quality of healthcare, and increasing access to healthcare for all citizens regardless of ability to pay. PHC4 has provided data to this entity in an effort to further PHC4’s mission of educating the public and containing healthcare costs in Pennsylvania. PHC4, its agents, and its staff have made no representation, guarantee, or warranty, express or implied, that the data—financial-, patient-, payor-, and physician-specific information—provided to this entity are error-free, or that the use of the data will avoid differences of opinion or interpretation. This analysis was not prepared by PHC4. This analysis was done by the Patient Safety Authority. PHC4, its agents, and its staff bear no responsibility or liability for the results of the analysis, which are solely the opinion of this entity.