ASPIRE Updates
Kate Buehler, MS, RN
ASPIRE Clinical Program Manager
July 26
th
2019
New Releases
• New Measures: CARD 03 and SUS 01
• Surgical Site Infection Toolkit now available!
• CPT Prediction Tool Released…Finally!
• Now capturing Preop and PACU data for Import Manager sites!
CARD 03: Available Monday
• Troponin I elevation >0.6ng/mL in high cardiac risk cases
• High Risk Surgeries
– Intraperitoneal
– Intrathoracic
– Suprainguinal Vascular
• Comorbidities (adapted from RCRI)- primarily flagged using ICD 9/10 codes
– Congestive Heart Failure
– Diabetes: Uncomplicated
– Diabetes: Complicated
– Coronary Artery Disease
– Chronic Kidney Disease (creatinine within 60 days >2.0)
• Inverse Measure (reported as percentage of high risk cases WITH elevated troponin I)
Outcome Measures
• Inverse Scores Coming!
– Monday, July 29: CARD 03
– Monday, August 5 for AKI 01
and CARD 02
• Will be included in the next
round of emails/MOCA
attestations
• Notify providers of this
upcoming change
SUS 01: Available Monday
• Mean fresh gas flow (FGF)
≤ 3L/min, during administration
of halogenated hydrocarbons
and/or nitrous oxide
• Relies on Insp % halogenated
agents for accurate score
• Without Insp %, flow N2O will
be used, if available
Avoiding Surgical Site Infection Toolkit: Available Now!
• Topics include:
– Antimicrobial Prophylaxis
– Normothermia
– Glycemic Control
– Fluid Management
– Oxygenation
– Hair Removal
– Operating Room Traffic
– Skin Prep
Anesthesia CPT Prediction in Measures
• Machine learning algorithm that takes
procedure text and predicts the top 3
anesthesia CPT codes
• Still need sites to submit CPT codes once
available
• Goal: Be less dependent on the billing
codes to send accurate measure feedback
CPT Prediction Caveats
• Algorithm for Selecting from Top 3 Predicted Codes:
– If difference in predicted confidence interval is >1.6x between 1
st
and 2
nd
code: Use 1
st
code only
For example: (01922: 70%, 00700: 20%, 01936: 10%)
– If difference between predicted 1
st
and 3
rd
code is >1.6x, will use 1
st
and 2
nd
code only
– For labor epidural and c-sections, will use 1st predicted code only
• CPT Prediction: Better than no codes but NOT perfect
– Machine continues to ‘learn‘ as codes are submitted
– Sites will provide us feedback that will allow us to manually improve the algorithms
Preop and PACU Data Available!
• Physiologic data
• Meds/Fluids
• PONV
• Level of Consciousness
• Nursing Documentation: Braden Scores/Fall Risk
• PACU Times (Phase 1 In/Out, Phase 2 In/Out, PACU Care Complete, Aldrete Scores)
• Sleep Apnea Preop Asssessment
• Some postoperative outcomes (reintubation, cardiac arrest, death, anaphylaxis, PDPH, etc)*
*Requires some data cleaning: lots of documentation indicating ‘Outcome: No’
Future Development
• PONV 03: Incidence of PONV in PACU- In progress
• Glycemic management: GLU 01 and 02 expand to preop/PACU
• Respiratory complications in PACU
• Other ideas?
– Opioid use in PACU?
– Antibiotic prophylaxis/timing?
– What projects do you need data for?
