This study assessed the value of AHRQ Patient Safety Indicator (PSI) rates as a measure of performance in Veterans Health Administration (VA) hospitals. Building on past efforts to study PSIs in the VA system, investigators concluded that PSIs are unreliable in comparing individual hospitals, largely due to the infrequent nature of most events. The authors advocate for use of PSIs in research settings rather than for purposes of measuring quality improvement interventions or rating the quality of individual providers.