| Measure | Description | NQS Domain | Denominator | Denominator exclusions and exceptions | Numerator | Rationale | Supporting Evidence | ASPIRE Measure | |
| Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision | This measure states the percentage of patients that received an antibiotic within 1 hour of surgical incision (2 hours for vancomycin or a flouroquinolone) for cases where antibiotic prophylaxis is required. Similar to NQF 0527 and 0269. | Patient Safety | All cases undergoing surgical procedures with an indication for surgical prophylaxis | Cases with documented exception/exclusion | All cases that received an antibiotic within 1 hour of surgical incision (2 hours for vancomycin or a flouroquinolone | Goal of prophylaxis with antibiotics is to establish bactericidal tissue and serum levels at the time of skin incision. | • American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins ACOG Practice Bulletin No 104 Antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol May 2009; 113(5) : 1180-1189. • Bernard HR, Cole WR. The prophylaxis of surgical infections: the effect of prophylactic antimicrobial drugs on the incidence of infection following potentially contaminated operations. Surgery. 1964;56:151-157. • Bratzler DW, Houck PM, for the Surgical Infection Prevention Guidelines Writers Group. Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project. CID. 2004:38(15 June):1706-1715. • Finkelstein R, Reinhertz G, Embom A. Surveillance of the use of antibiotic prophylaxis in surgery. Isr J Med Sci. 1996;32:1093-1097. • Gorecki P, Schein M, Rucinski JC, et al. Antibiotic administration in patients undergoing common surgical procedures in a community teaching hospital: the chaos continues. World J Surg. 1999;23:429-432. • Larsen RA, Evans RS, Burke JP, et al. Improved perioperative antibiotic use and reduced surgical wound infections through use of computer decision analysis. Infect Control Hosp Epidemiol. 1989;10:316-320. • Mangram AJ, Horan TC, Pearson ML, et al. Guidelines for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20:247-280. • Polk HC, Lopez-Mayor JF. Postoperative wound infection: a prospective study of determinant factors and prevention. Surgery. 1969;66:97-103. • Silver A, Eichorn A, Kral J, et al. Timeliness and use of antibiotic prophylaxis in selected inpatient surgical procedures. Am J Surg. 1996;171:548-552. • Stone HH, Hooper CA, Kolb LD, et al. Antibiotic prophylaxis in gastric, biliary, and colonic surgery. Ann Surg. 1976;184:443-452. |
INF 01 | |
| Train of Four Monitor Documented After Last Dose of Non-depolarizing Neuromuscular Blocker | The Train of Four Documented measure states the percentage of the EP's cases with documentation of a Train of Four count or acceleromyography result after the last dose of a non-depolarizing muscle relaxant | Effective Clinical Care | All cases that received either by bolus or infusion a non-polarizing neuromuscular blocker (NMB) AND were extubated post-operatively or in the PACU. The following NMBs were included: 1. Atracurium 2. Cisatracurium 3. Pancuronium 4. Rocuronium 5. Vecuronium |
Cases that were not extubated in the immediate post-operative period | All cases with documentation of either a Train of Four count (1, 2, 3, or 4) or TOF ratio provided by acceleromyography AFTER last dose or stopping of infusion of neuromuscular blocker. | The purpose of this quality measure is to help reduce the number of patients who have residual neuromuscular blockade after extubation. | • Pedersen T, Viby-Mogensen J, Ringsted C. Anaesthetic practice and postoperative pulmonary complications. Acta Anaesthesiol Scand 1992; 36:812-8. • Beecher HK, Todd DP. A study of the deaths associated with anesthesia and surgery: based on a study of 599, 548 anesthesias in ten institutions 1948-1952, inclusive. Ann Surg 1954; 140:2-35. • Harrison GG. Death attributable to anaesthesia. A 10-year survey (1967-1976). Br J Anaesth 1978; 50:1041-6. • Lunn JN, Hunter AR, Scott DB. Anaesthesia-related surgical mortality. Anaesthesia 1983; 38:1090-6. • Grosse-Sundrup M, Henneman JP, Sandberg WS, Bateman BT, Uribe JV, Nguyen NT, Ehrenfeld JM, Martinez EA, Kurth T, Eikermann M. Intermediate acting non-depolarizing neuromuscular blocking agents and risk of postoperative respiratory complications: prospective propensity score matched cohort study. BMJ 2012; 345:e6329 |
NMB 01 | |
| Administration of Neostigmine before Extubation for Cases with Nondepolarizing Neuromuscular Blockade | The Administration of Neostigmine measure states the percentage of your patients that receive neostigmine after you have given a non-depolarizing neuromuscular blocker. | Effective Clinical Care | All cases that received either by bolus or infusion a non-depolarizing neuromuscular blocker (NMB) AND were extubated post-operatively or in the PACU. The following NMBs were included: 1. Atracurium 2. Cisatracurium 3. Pancuronium 4. Rocuronium 5. Vecuronium |
1. Cases that were not extubated in the immediate post-operative period 2. Cases where patients (age > 12) received only defasciculating doses of non-depolarizing neuromuscular blockers (Vecuronium ≤ 1mg, Cisatracurium ≤ 2mg, Rocuronium ≤ 10 mg |
All cases with documentation of neostigmine BEFORE extubation or greater than 4 hours between last dose of non-depolarizing medication and extubation. | The purpose of this quality measure is to help reduce the number of patients who have residual neuromuscular blockade after extubation. | • Pedersen T, Viby-Mogensen J, Ringsted C. Anaesthetic practice and postoperative pulmonary complications. Acta Anaesthesiol Scand 1992; 36:812-8. • Beecher HK, Todd DP. A study of the deaths associated with anesthesia and surgery: based on a study of 599, 548 anesthesias in ten institutions 1948-1952, inclusive. Ann Surg 1954; 140:2-35. • Harrison GG. Death attributable to anaesthesia. A 10-year survey (1967-1976). Br J Anaesth 1978; 50:1041-6. • Lunn JN, Hunter AR, Scott DB. Anaesthesia-related surgical mortality. Anaesthesia 1983; 38:1090-6. • Grosse-Sundrup M, Henneman JP, Sandberg WS, Bateman BT, Uribe JV, Nguyen NT, Ehrenfeld JM, Martinez EA, Kurth T, Eikermann M. Intermediate acting non-depolarizing neuromuscular blocking agents and risk of postoperative respiratory complications: prospective propensity score matched cohort study. BMJ 2012; 345:e6329 |
NMB 02 | |
| Administration of insulin or glucose recheck for patients with hyperglycemia | The Treatment of Perioperative Hyperglycemia measure states the percentage of occurrences that the EP administered insulin or checked a glucose level within 90 minutes of when the documented glucose level was greater than 200 mg/dL. | Effective Clinical Care | All glucose measurements greater than 200 mg/dL between Anesthesia Start time and Anesthesia End time. | 1. Outpatient cases with Anesthesia Start to Anesthesia end time less than 4 hours long 2. Glucose measurements > 200 mg/dL less than 90 minutes before Anesthesia End |
1. Occurrences of administration of insulin within 90 minutes (either IV or sub Q routes) of glucose measurement greater than 200 mg/dL or 2. Occurrences of glucose level checks within 90 minutes of glucose measurement greater than 200 mg/dL |
The purpose of this measure is to prevent prolonged periods of hyperglycemia. Acute hyperglycemia in the perioperative period is known to increase the incidence of wound infections, as well as overall mortality. | • Frisch A, Chandra P, Smiley D, et al. Prevalence and Clinical Outcome of Hyperglycemia in the Perioperative Period in Noncardiac Surgery. Diabetes Care 2010;33(8):1783-1788. doi:10.2337/dc10-0304. • Ramos M , Khalpey Z , Lipsitz S , Steinberg J , Panizales MT , Zinner M , Rogers SO Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery. Ann Surg 248 (2008):585–591 • Gandhi GY1, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, Williams BA, Schrader LM, Rizza RA, McMahon MM. Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. Mayo Clin Proc. 2005 Jul; 80(7):862-6. |
GLU 01 | |
| Administration of dextrose containing solution or glucose recheck for patients with perioperative glucose < 60 | The Treatment of Intraoperative Hypoglycemia measure states the percentage of cases that the EP administered a dextrose containing solution or checked a glucose level within 90 minutes of when the documented glucose level was less than 60 mg/dL. | Patient Safety | All glucose measurements less than 60 mg/dL between Anesthesia Start time and Anesthesia End time. | Glucose measurements less than 60 mg/dL less than 90 minutes before Anesthesia End | 1. Occurrences of administration of dextrose containing solution (IV) within 90 minutes of glucose measurment less than 60 mg/dL or 2. Occurrences of glucose checks within 90 minutes of glucose measurment less than 60 mg/dL |
The purpose of this measure is to prevent prolonged periods of hypoglycemia. Acute hypoglycemia in the perioperative period can lead to inadequate supply of glucose to the brain, resulting in seizures, permanent brain damage, and death. The common signs/symptoms of hypoglycemia are masked by general anesthesia, making vigilance and quick treatment especially important | Akhtar S, Barash PG, Inzucchi SE. Scientific principles and clinical implications of perioperative glucose regulation and control. Anesth Analg 2010; 110:478–97 Schwenk ES, Mraovic B, Maxwell RP, et al. Root causes of intraoperative hypoglycemia: a case series. Journal of Clinical Anesthesia. 2012 Dec; 24 (8): 625-630 |
GLU 02 | |
| Lung Protective Ventilation |
The lung protective ventilation measure states the percentage of cases that the EP adminstered a lung protective (less than 10 ml/kg ideal body weight) ventilation technique | Patient Safety | All patients undergoing general anesthetics with positive pressure ventilation and endotracheal intubation | 1. Cases arriving to operating room intubated or transported directly to ICU 2. Outpatient cases with Anesthesia Start to Anesthesia end time less than 4 hours long |
Cases with median tidal volume < 10 ml/ kg ideal body weight | The purpose of this measure is to prevent pulmonary injury to excessively high tidal volumes. | Futier E, Constantin JM, Paugam-Burtz C, Pascal J, Eurin M, Neuschwander A, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013; 369(5):428-37 PMCID: 23902482. | PULM 01 | |
| Perioperative normothermia | This measure states the percentage of cases at increased risk of hypothermia that the EP provided active warming | Effective Clinical Care | Cases with primary anesthesia technique of general anesthesia, spinal anesthesia, epidural anesthesia | Cases less than 60 minutes | Cases with documentation of convective warming device | Nirav Shah:
American Society of PeriAnesthesia Nurses. ASPAN's evidence-based clinical practice guideline for the promotion of perioperative normothermia. Cherry Hill (NJ): American Society of PeriAnesthesia Nurses (ASPAN); 2009. 20 p. AHRQ Bennett J, Ramachandra V, Webster J, Carli F. Prevention of hypothermia during hip surgery: effect of passive compared with active skin surface warming. Br J Anaesth. 1994 Aug;73(2):180-3. PubMed Brauer A, Perl T, Uyanik Z, English MJ, Weyland W, Braun U. Perioperative thermal insulation: minimal clinically important differences. Br J Anaesth. 2004 Jun;92(6):836-40. PubMed Carli F, Emery PW, Freemantle CA. Effect of peroperative normothermia on postoperative protein metabolism in elderly patients undergoing hip arthroplasty. Br J Anaesth. 1989 Sep;63(3):276-82. PubMed Frank SM, Beattie C, Christopherson R, Norris EJ, Rock P, Parker S, Kimball AW Jr. Epidural versus general anesthesia, ambient operating room temperature, and patient age as predictors of inadvertent hypothermia. Anesthesiology. 1992 Aug;77(2):252-7. PubMed |
N/A | ||
| Perioperative normothermia | This measure states the percentage of cases at increased risk of hypothermia that the EP documented temperature | Effective Clinical Care | Cases with primary anesthesia technique of general anesthesia, spinal anesthesia, epidural anesthesia | Cases less than 60 minutes | Cases with documentation of patient temperatue | Nirav Shah:
Core temperatures outside the normal range pose a risk in all patients undergoing surgery. According to the Clinical Guidelines for the Prevention of Unplanned Perioperative Hypothermia by the American Society of PeriAnesthesia Nurses (ASPAN, 2009), published research has correlated impaired wound healing, adverse cardiac events, altered drug metabolism, and coagulopathies with unplanned perioperative hypothermia. A study by Kurz et al. (1996) found that incidence of culture-positive surgical site infections among those with mild perioperative hypothermia was three times higher than the normothermic perioperative patients. In this study, mild perioperative hypothermia was associated with delayed wound closure and prolonged hospitalization. In a meta-analysis of outcomes and costs, Mahoney and Odom (1999) demonstrated that hypothermia is associated with a significant increase in adverse outcomes, including an increased incidence of infections. The authors also concluded that hypothermia is associated with an increased chance of blood products administration, myocardial infarction, and mechanical ventilation. These adverse outcomes resulted in prolonged hospital stays and increased healthcare expenditures.From AHRQ |
American Society of PeriAnesthesia Nurses. ASPAN's evidence-based clinical practice guideline for the promotion of perioperative normothermia. Cherry Hill (NJ): American Society of PeriAnesthesia Nurses (ASPAN); 2009. 20 p. Bennett J, Ramachandra V, Webster J, Carli F. Prevention of hypothermia during hip surgery: effect of passive compared with active skin surface warming. Br J Anaesth. 1994 Aug;73(2):180-3. PubMed Brauer A, Perl T, Uyanik Z, English MJ, Weyland W, Braun U. Perioperative thermal insulation: minimal clinically important differences. Br J Anaesth. 2004 Jun;92(6):836-40. PubMed Carli F, Emery PW, Freemantle CA. Effect of peroperative normothermia on postoperative protein metabolism in elderly patients undergoing hip arthroplasty. Br J Anaesth. 1989 Sep;63(3):276-82. PubMed Frank SM, Beattie C, Christopherson R, Norris EJ, Rock P, Parker S, Kimball AW Jr. Epidural versus general anesthesia, ambient operating room temperature, and patient age as predictors of inadvertent hypothermia. Anesthesiology. 1992 Aug;77(2):252-7. PubMed |
N/A | |
| Post-operative nausea and vomiting prevention (PONV) - Adult | This measure states the percentage of adult cases at increased risk of post-operative nausea and vomiting that the EP administered 2 or more classes of antiemetic prophylaxis | Person and Caregiver-Centered Experience and Outcomes | Cases with anesthetic technique of general anesthesia | Cases with general anesthesia without use of inhalational anesthetic (TIVA) Cases with fewer than 3 risk factors for PONV (female gender, non smoker, PONV/motion sickness history, opiate administration) |
Cases with administration of 2 or more classes of anti-emetics (5HT3 antagonist, steroids, phenothiazine, IM ephedrine, butyrophenone, antihistamine, or anticholinergic) | PONV is a relatively common side effect of anesthesia. It can be highly unpleasant for both patients and staff, but fortunately is rarely life-threatening. PONV can lead to prolonged PACU stay and hospitalization. The incidence of PONV can be reduced by prophylaxis with multiple classes of anti-emetics. | Apfel, CC, Korttila K, Abdalla M, Kerger H et al. A Factorial Trial of Six Interventions for the Prevention of Postoperative Nausea and Vomiting. New England Journal of Medicine. 350 (24): 2441-2451 Gupta A, Wu C, Elkassabany N, Krug CE, Parker SD, Fleisher LA. Does the Routine Use of Antiemetics Affect the Incidence of Postdischarge Nausea and Vomiting foloowing Ambulatory Sergery. Anesthesiology. 99: 488-95 (2003) |
N/A | |
| Post-operative nausea and vomiting prevention (PONV) - Pediatric | This measure states the percentage of pediatric cases at increased risk of post-operative nausea and vomiting that the EP administered 2 or more classes of antiemetic prophylaxis | Person and Caregiver-Centered Experience and Outcomes | Cases with anesthetic technique of general anesthesia | Cases with general anesthesia without use of inhalational anesthetic (TIVA) Fewer than 2 risk factors for PONV • Surgery ≥ 30 minutes • Age ≥ 3 years • Strabismus surgery • History of POV or PONV in parent or sibling |
Cases with administration of 2 or more classes of anti-emetics | PONV is a relatively common side effect of anesthesia. It can be highly unpleasant for both patients and staff, but fortunately is rarely life-threatening. PONV can lead to prolonged PACU stay and hospitalization. The incidence of PONV can be reduced by prophylaxis with multiple classes of anti-emetics. A separate pediatric measure is necessary because the risk factors and recommended prophylaxis are different from adults. | Höhne, C. Postoperative Nausea and Vomiting in Pediatric Anesthesia. Current Opinions in Anesthsiology. 27 (3): 303-308 (2014) Rose JB, Watcha MF. Postoperative Nausea and Vomiting in Paediatric Patients. British Journal of Anaesthesia. 83(1): 104-17 (1999) |
N/A | |
| Prevention of unnecessary colloid administration | This measure states the percentage of cases where colloid was not administered (for patients that likely do not need colloid | Efficiency and Cost Reduction | All cases under the care of an anesthesia provider | Cases with >=4 units of intraoperative PRBC transfused Cases with EBL >= 2000 ML Cases with prone position > 4 hours anesthesia time Any case > 8 hours anesthesia time |
Cases with administration of 5% albumin, 25% albumin, hetastarch, pentastarch, and voluven | Avoiding colloid and using crystalloid instead when appropriate is part of ASA's Choosing Wisely program | Perel P, Roberts I, Pearson M. Colloid versus crystalloid for fluid resuscitation in critically ill patients (Review). The Cochrane Collaboration, the Cochrane Library 2009;3. Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2013 Feb 28;2. Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2012 Jun 13;6. Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2011 Mar 16;(3):CD000567. Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD000567. Roberts I, Alderson P, Bunn F, Chinnock P, Ker K, Schierhout G. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2004 Oct 18;(3):CD000567. Kruer RM Ensor CR. Colloids in the intensive care unit. Am J Health Syst Pharm. 2012 Oct 1;69(19):1635–42. NATA: Network for Advancement and Transfusion Alternatives. Crystalloids versus colloids: the controversy [Internet]. NATA. 2013 [cited 2013 Sep 20]. Available from: http://www.nataonline.com/np/158/crystalloids-versus-colloids-controversy. Reinhart K, Perner A, Sprung CL, Jaeschke R, Schortgen F, Johan Groeneveld AB, Beale R, Hartog CS; European Society of Intensive Care Medicine. Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients. Intensive Care Med. 2012;38(3):368–83. |
N/A | |
| Transfusion management vigilance | This measure states the percentage of cases with documentation of hematocrit or hemoglobin before or concurrent with transfusion of red blood cells | Effective Clinical Care | Cases under care of anesthesia provider | Cases with 4 or more units of blood transfused, to account for the situation of treating acute exsanguination Cases with EBL >= 2000 ML Cases with age of patient less than 6 years old, due to the possible need for transfusions in patients with congenital heart disease |
Cases with documented hematocrit or hemoglobin before or concurrent with intraoperative transfusion | Providing a transfusion to a patient without checking the hematocrit first, to confirm the patient needs the blood, can lead to unnecessary risk and costs. | Practice Guidelines for Perioperative Blood Management: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management. Anesthesiology. 122: 2. 241-75 Napolitano LM, et al, Clinical Practice Guideline: Red Blood Cell Transfusion in Adult Trauma and Critical Care, Critical Care Medicine of the Society of Critical Care Medicine and the Eastern Association for the Surgery of Trauma Practice Management Workgroup. Crit Care Med., Vol. 37, No. 12; Dec. 2009, pp 3124-3157 |
N/A | |
| AppropriateTransfusions Trigger | This measure states the percentage of cases where post-transfusion hematocrit is less than 30%, or hemoglobin less than 10. | Efficiency and Cost Reduction | Cases under care of anesthesia provider | Cases with 4 or more units of intraoperative PRBC transfused EBL >= 2000 ML Patient with documented reason for exclusion or physiologic need |
Cases with documented hematocrit less than 30 or hemoglobin less than 10 after last transfusion of red blood cells. | Studies on transfusion and outcomes have demonstrated that most situations transfusing over Hct 28 adds risk and expense, with worse patient outcomes. | Practice Guidelines for Perioperative Blood Management: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management. Anesthesiology. 122: 2. 241-75 Napolitano LM, et al, Clinical Practice Guideline: Red Blood Cell Transfusion in Adult Trauma and Critical Care, Critical Care Medicine of the Society of Critical Care Medicine and the Eastern Association for the Surgery of Trauma Practice Management Workgroup. Crit Care Med., Vol. 37, No. 12; Dec. 2009, pp 3124-3157 |
N/A | |
| Appropriate intraoperative handoff | This measure states the percentage of intraoperative anesthesia staff changes where completion of a predefined handoff checklist is documented. | Communication and Care Coordination | All intraoperative staff changes between anesthesia providers | Cases where there are not any handoffs between anesthesia providers | Staff changes where a review of a predefined handoff checklist between providers is documented | Lack of communication or miscommunication between anesthesia providers during staff change can lead to patient harm. Organizing these staff changes using a predefined handoff checklist ensures this communication occurs, and is as accurate and efficient as possible.. | Boat AC, Spaeth JP. Handoff Checklists Improve the reliability of Patient Handoffs in the Operating Room and Postanesthesia Unit. Pediatric Anesthesia. 23 (2013): 647-654 Agarwala AV, Firth PG, Albrecht MA, Warren L, Musch, G. An Electronic Checklist Improves Transfer nd Retention of Critical Information at Intraoperative Handoff of Care. Anesthesia and Analgesia. 120 (2015): 96-104 |
N/A | |
| Appropriate transition of care | This measure states the percentage of OR to PACU transitions of care where completion of a predefined handoff checklist is documented | Communication and Care Coordination | All cases where patients are transferred from operating room to PACU at end of procedure. |
Cases were patients are transferred directly to ICU from operating room. | Cases with documentation of completed handoff between anesthesia provider and PACU clinician | Lack of communication or miscommunication between anesthesia providers and PACU staff during transitions of care can lead to patient harm. Organizing these transitions using a predefined handoff checklist ensures this communication occurs, and is as accurate and efficient as possible.. | Ong M, Coiera E. A Systmatic Review of Failures in Handoff Communication During Intrahospital Transfers. The Joint Commission Journal on Quality and Patient Safety. 37:6 (2011). 274-284 Smith AF, Pope C, Goodwin D, Mort M. Interprofessional Handover and Patient Safety in Anaesthesia: Observational Study of Handovers in the Recovery Room. British Journal of Anaesthesia. 101 (3): 332-7 (2008) |
N/A | |
| Appropriate Blood Pressure Management | This measure states the percentage of cases with mean arterial pressure less than 55 mmHg for 20 minutes or longer | Patient Safety | All cases managed by anesthesia provider for patients 18 years old or older | Cases with patients less than 18 years old | Cases where the MAP is below 55 mmHg for more than 20 minutes between Anesthesia Start and Anesthesia End | A drop in MAP below 55 mHg during surgery puts the patient at higher risk for postoperative cardiac adverse events (CAEs) and acute renal injury | Walsh M, et al. Relationship between Intraoperative Mean Arterial Pressure and Clinical Outcomes after Noncardiac Surgery. Anesthesiology, Vol. 119, No. 3; Sept. 2013, pp 507-515. Kheterpal S, et al. Preoperative and Intraoperative Predictors of Cardiac Adverse Events after General, Vascular, and Urological Surgery. Anesthesiology, Vol. 110, No. 1; Jan. 2009, pp 58-66. |
N/A | |
| Blood Pressure Monitoring Vigilance | This measure states the percentage of cases without gaps in systolic or mean arterial pressure during case of 20 minutes or more. | Effective Clinical Care | All cases managed by anesthesia provider for patient | None | Cases with monitoring gap in blood pressure greater than 20 minutes | Standard ASA monitoring includes taking blood pressure at regular intervals to prevent hypotension and hypertension | http://www.asahq.org/~/media/Sites/ASAHQ/Files/Public/Resources/standards-guidelines/standards-for-basic-anesthetic-monitoring.pdf | N/A | |
| Myocardial Injury | This measure states the percentage of cases with Troponin I > 1.00 within 4 postoperative days | Outcome | All cases | Cases with recent Troponin I elevation Cases with significant preexisting cardiac disease |
Cases with troponin I > 1.00 within 4 postoperative days | Post-operative mycardial injury can lead to permanent sequalae for patients (including death). Preventing myocardial injury is an important anesthetic goal | Landesberg G, Beattie WS, Mosseri M, Jaffe AS, Alpert JS. Perioperative Myocardial Infarction. Circulation. 119: 2936-2944 (2009) | N/A | |
| Kidney Injury | This measuere states the percentage of cases where creatinine increased postoperatively | Outcome | All cases requiring inpatient stay postoperatively | Outpatient surgery Patients with preexisting renal dysfunction Patient undergoing urologic surgery or surgery directly affecting kidneys Patients where creatinine not available within 7 days postoperatively |
Patients with a creatinine increase of .3 mg/dl within 48 hours of surgery end Patients with increases in creatinine 1.5 baseline (as measured within first 7 postoperative days) |
Post-operative kidney injury can lead to permanent sequalae for patients (including dialysis). Preventing kidney injury is an important anesthetic goal | Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney inter., Suppl. 2013; 3: 1-150. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney inter., Suppl. 2012; 2: 1–138. |
N/A | |
| Post-operative pain | This measure states the percentage of cases where peak pain score < 8 in the PACU | Outcome | All adult cases where patient was admitted to PACU postoperatively | Cases with preop pain score of 2 or greater Cases with documented inability to measure preoperative pain score (i.e due to mental status changes) |
Cases where peak pain score is less than 8 on scale of 0-10 | Keeping patients comfortable in the PACU is part of quality patient care, and a comparison of Preop to Postop pain scores is one indicator of patient comfort. | Acute Pain Management: Operative or Medical Procedures and Trauma, Clinical Practice Guideline No. 1. AHCPR Publication No. 92-0032; February 1992. Agency for Healthcare Research & Quality, Rockville, MD; pages 116-117. | N/A | |
| Mortality | This measure states the percentage of cases that resulted in patient death within the surgical episode of care | Outcome | All cases requiring inpatient stay postoperatively | ASA 5 and 6 | Patients who died before hospital discharge | All cause mortality can be a reasonable method to assess overall quality of care. | N/A | ||
| Immediate Perioperative Mortality | This measure states the percentage of cases that resulted in patient death in the procedure/ operating room/ or PACU | Outcome | All cases | ASA 5 and 6 | Patients who died before PACU discharge | Perioperatve mortality | N/A | ||
| Medication Overdose | This measure states the percentage of cases where either naloxone or flumazenil was adminstered to treat a medication overdose | Outcome | All cases receiving a narcotic or benzdiazepine during their intraoperative course | (Electroconvulsive therapy) ECT Patients Cases utilizing neuraxial anesthesia with administration of naloxone for pruritus |
Cases with administration of bolus dose or infusion of naloxone or flumazenil | Flumazenil is given for benzodiazepine (midazolam) overdose Naloxone is given for narcotic overdose |
N/A | ||
From AHRQ