ASPIRE Measure Survey Results
Names
Text Response
Sachin Kheterpal
Simon Tom
Mike Aziz
Teus Kappen
Christopher Wedeven, MD
Lee Fleisher
William Paganelli
Nirav Shah
Peter Fleischut
Bhiken Naik
Satya Krishna Ramachandran
Fabian Kooij
Tim Morey
Philipp Lirk
Nathan Pace
Janet Wilczak
Karen Domino
Jerry Epps
John LaGorio
Lebron Cooper, MD
Stefanich, Lyle J
Dan Biggs
Stefan Ianchulev, MD
Roy Soto
Aimee Becker
Leslie Jameson
Paul St Jacques
Mackenzie Kuhl
Anshuman Sharma
Institutions
University of Michigan
NYU Langone Medical Center
OHSU
University Medical Center Utrecht
Holland Hospital
University of Pennsylvania
University of Vermont
University of Michigan Health System
Weill Cornell Medical College
University of Virginia
UMHS
AMC, Amsterdam
University of Florida
Academic Medical Center, University of
Amsterdam, The Netherlands
University of Utah
Oakwood Hospital Dearborn Michigan
University of Washington
University of Tennessee Medical Center
Mercy Health Muskegon
Henry Ford Hospital
University of Oklahoma
University of Oklahoma
Tufts Medical Center
Beaumont Health
UWSMPH
University of Colorado
Vanderbilt
Marquette General Hospital
Washington University School of Medicine
Performance Measure Survey - SCIP
Mean
Score
Standard
Deviation
Min
Score
Max
Score
SCIP 1
(Abx)
6.93
2.80
1
10
SCIP
2 (Temp)
7.00
2.85
1
10
SCIP 3 (beta blockade)
6.38
2.80
1
10
Mean Score
Standard
Deviation
Min Score
Max Score
NMB
- TOF
7.52
1.82
4
10
NMB
- Neostigmine
7.28
2.19
2
10
Neuromuscular Blockade
Mean Score
Standard Deviation
Min Score
Max Score
No 10
min gap
6.83
2.66
1
10
Monitoring Vigilance
Transfusion Management
Mean
Score
Standard Deviation
Min Score
Max Score
Receiving PRBC
6.41
2.46
1
10
Documented
Hct
7.28
2.10
1
10
PACU
Hct
7.45
1.94
1
10
Hct
nadir
6.21
2.23
1
10
Glucose Management
Mean Score
Standard Deviation
Min Score
Max
Score
Insulin or recheck
8.17
1.26
6
10
Recheck after insulin
7.59
2.04
1
10
Dextrose or recheck
7.17
1.98
3
10
Ventilator Management
Mean
Score
Standard
Deviation
Min Score
Med Score
< 10
mins
at 10cc/kg
6.83
2.54
1
10
< 20
mins
at 10cc/kg
7.59
2.06
1
10
Colloid Management
Mean
Score
Standard Deviation
Min Score
Max Score
Albumin
5.03
2.37
1
8
Hetastarch
/
Pentastarch
/
4.55
2.05
1
8
PONV
Mean
Score
Standard
Deviation
Min Score
Max Score
2
classes anti-emetics
7.21
1.93
1
10
Overdose
Mean Score
Standard
Deviation
Min Score
Max Score
Naloxone
6.72
2.43
1
10
Flumazenil
5.93
2.72
1
10
End Organ Failure
Mean Score
Standard
Deviation
Min Score
Max Score
Reintubation
8.28
1.65
4
10
Troponin
7.45
2.28
1
10
AKI
7.48
2.20
1
10
Mean Score
Standard Deviation
Min Score
Max Score
Pain Score
7.55
1.97
4
10
Pain Management
Some of the thing (like albumin) are not common in our Country
@22/23: cannot deliver... don't have labs after 24 hours
The direction of benefit (high number or low number best) should be standardized for all quality measures. I
favor making a small number (zero) be the best possible response
The language describing quality measures should be standardized to avoid ambiguity.
In particular, #2 is ambiguous. Is the quality measure the use of warming devices, the avoidance of
hypothermia or both?
Examples of rewriting the quality measures:
#24: Proportion of patients with peak pain score > 8 in PACU.
#1: Proportion of patients not receiving antibiotics within the SCIP recommended time window.
#!5: Proportion of patients receiving sustained intraoperative mechanical ventilation with tidal volumes >= 10
ml/Kg IBW for 20 or more minutes.
I am very interested in the role that residual NMblockade plays in prolonged intubation or reintubation.
However, from the cases that I have reviewed in our data base the reversal and monitoring appear to have
been done. The sensitivity of the monitor being used and variability in monitoring site could play a significant
role. Also the time between the last NM blocker dose and the reversal dose may have an effect. Not sure what
we will capture with documenting reversal alone.
With regard to the troponin level and creatinine levels I hesitate to correlate a care time interval of 4 to 7 post
operative days directly with anesthesia care. How do you plan to separate the care of the intraoperative
physicain from the post operative care team?
temperature normothermic (maybe above 36.5) at end of the case should be used rather than warming per se
to drive change. My preference is to focus on the AQI measures for pay for performance as those that are of
highest priority.
I am conflicted. Some of these are statisics I would like to know, but I don't necessarily think they are quality
indicators
--
or are quality indicators for certain types of cases, but not all. Additionally, some of the data will be
difficult to get depending on the EMR combinations that practices have. Call me if you would like to discuss
this in greater detail. Respectfully, Lyle Stefanich
#4 and 5
- if patient is extubated. Not if left intubated.
#14, 15, 16 and 17
- "without"? Should it be "with"?
#18 All patients or those with risk factors receive prophylaxis
SCIP and other upcoming CMS measures should be prioritized.
I would consider capturing PACU pain scores < or =5 and those > or = 8.
Most commonly postanesthesia check of the patient occurs within 48 hrs. Not all institutions may have ways of
documenting troponin and creatinin in periods greater than that. This however would be a great measure to
apply when AIMS becomes part of a bigger, integrated documentation system i.e. Epic.
I would consider capturing patients who receive volume expanders instead of those who do not...
Every PRBC administered intraoperatively or in the PACU/ICU should be tied to a documented Hct within +/
-
60
min of administration.
In general, SCIP measures are so closely monitored in
-house that these aren't very important-- pretty much
everybody already knows they do well.
The tidal volume is too high. Most of the current stuff says 6 range and it is calculated on height or ideal body
weight not actual body weight. I think the overdose is a rare event so might pass but glucose management is a
big deal.
Many of these are very dependent on exclusion criteria which are not included in the text. Ex troponin except
in cardiac surgery. As is frequently the case those details are the difference between a good indicator or not.
4
5
6
7
8
Mean Survey Score by Category
