Proposed QI Reports v2014
The QI reports are divided into three major domains:
Process of care
o Externally established metrics (SCIP, etc)
o Internally developed
Clinical outcome
Exploratory
Due to the relative lack of NQF-endorsed perioperative measures applicable to the anesthesiology provider, many
QI reports are based upon commonly accepted clinical practices developed by the MPOG member institution
representatives. There are two basic dashboards made available: departmental and provider. The departmental
dashboard is exposed to departmental or institution leadership and enabled cross-center comparison with drill-
down into individual (anonymized) providers. The provider dashboard is designed for each individual clinician to
review their own performance within centers. Reports can be filtered by primary surgical procedure or primary
ICD9 procedure code. For all current measures, ASA 5 or 6 patients are excluded, as are procedures with < 45
minutes of anesthesia time (start to end). Currently, all measures are designed for use with adult patient
populations only.
Process of care -- SCIP
SCIP-INF1 – Timing of prophylactic antibiotics
SCIP-INF10 – Perioperative normothermia and warming
SCIP-CARD2 – Continuation of beta-blockade in patients with chronic beta blockade therapy
Process of care -- Internally developed
Intraoperative neuromuscular blockade monitoring and treatment
o Exclusions
Patients arriving to operating room intubated or transported directly to ICU
o Measures
Proportion of patients receiving a non-depolarizing neuromuscular blockade medication
with documentation of neuromuscular function recovery (TOF twitches)
Proportion of patients receiving a non-depolarizing neuromuscular blockade medication
with administration of neostigmine if time from last administration to extubation is < 4
half-lives (specific to drug administered)
o Threshold
95%
Monitoring vigilance
o Exclusions
Emergency patients
o Measures
Proportion of patients without a 10 minute gap in systolic or mean arterial pressure
between patient in room and patient out of room
o Threshold
95%
Discretionary transfusion management
o Exclusions
Patients with >=4 units of intraoperative PRBC transfused
EBL >= 2000 ML
Outpatient surgery
o Measures
Patients receiving PRBC at all
Patients receiving PRBC at all with a measured and documented hematocrit or
hemoglobin within 60 minutes
Patients receiving PRBC with a first post anesthesia end (within 6 hours) hematocrit >
32.0
Intraoperative hematocrit or hemoglobin nadir
o Thresholds
In development
Glucose management
o Exclusions
Pancreatic transplants
o Measures
Patients with perioperative glucose > 250 (between anesthesia start-2 hours and
anesthesia end + 2 hours) with an insulin bolus or infusion or glucose recheck
Patients with insulin given (between anesthesia start and anesthesia end), recheck
within 120 minutes (anesthesia end + 2 hours)
Patients with glucose < 60 (between anesthesia start-2 hours and anesthesia end) with a
glucose recheck of treatment with dextrose containing solution (between anesthesia
start and anesthesia end + 2 hours)
Intraoperative ventilator management
o Exclusions
Patients arriving to operating room intubated or transported directly to ICU
Outpatient surgery
Patients without an endotracheal intubation during procedure
o Measures
Patients without sustained intraoperative tidal volume > 10 ml/kg ideal body weight for
10 continuous minutes or greater
Patients without sustained intraoperative tidal volume > 10 ml/kg ideal body weight for
20 minutes or greater
o Thresholds
In development
Fluid management
o Exclusions
Patients with >=4 units of intraoperative PRBC transfused
EBL >= 2000 ML
Outpatient surgery
Prone surgery > 4 hours anesthesia time
Any surgery > 8 hours anesthesia time
o Measures
Patients without administration of albumin (5%, 25%, 10%) between anesthesia start
and end
Patients without administration of hetastarch, pentastarch, or voluven between
anesthesia start and end
o Thresholds
85%
Postoperative nausea and vomiting prophylaxis in patients undergoing general anesthetic with
inhalational anesthesia
o Exclusions
Non-general anesthetic
General anesthetic without use of inhalational anesthetic
Fewer than 3 risk factors for PONV (female gender, non smoker, PONV/motion sickness
history, opiate administration)
o Measure
Patients with administration of 2 or more classes of antiemetics between anesthesia
start-6 hours to anesthesia end (5HT3 antagonist, steroids, phenothiazine, IM
ephedrine, butyrophenone, antihistamine, or anticholinergic)
o Thresholds
95%
Clinical outcome
Medication overdosing
o Exclusions
Electroconvulsive therapy patients
o Measures
Any patient receiving any dose of naloxone
Any patient receiving any dose of flumazenil
o Thresholds
0
End organ damage or failure
o Exclusions
Arrived to OR intubated
Serum Troponin-I measured within 60 days prior to anesthesia start
Baseline serum creatinine > 4.0 within 60 days prior to anesthesia start
o Measures
Reintubated in recovery room or operating room
Postoperative troponin-I > 1.00 within 4 postoperative days
Postoperative Stage I, kidney injury (KDIGO criteria)
1.5 x baseline serum creatinine (measured within 60 preoperative days)
observed in first 7 postoperative days
0.3 mg/dl rise in creatinine within 48 hours
o Thresholds
In development
Pain management
o Exclusions
Any patient with baseline preoperative pain score >=2 (on VAS scale 1 – 10)
o Measure
Peak pain score in recovery <= 5
Peak pain score in recovery <= 8
o Thresholds
In development
Exploratory variation in care analyses
Anesthesia technique
o Patients with an arterial line
o Patients with a central venous catheter
o Patients receiving a general anesthetic
o Patients receiving a Peripheral nerve block
o Patients receiving an epidural
o Patients receiving a spinal
o Patients receiving a spinal and a GA
