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  • Measure Summary
  • NQMC:010659
  • Oct 2015

Perioperative care: percentage of patients, regardless of age, who undergo a procedure under anesthesia and are admitted to an ICU directly from the anesthetizing location, who have a documented use of a checklist or protocol for the transfer of care from the responsible anesthesia practitioner to the responsible ICU team or team member.

American Society of Anesthesiologists (ASA). Post-anesthetic transfer of care: use of checklist or protocol for direct transfer of care from procedure room to intensive care unit (ICU). Schaumburg (IL): American Society of Anesthesiologists (ASA); 2015 Oct 1. 2 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

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Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients, regardless of age, who undergo a procedure under anesthesia and are admitted to an intensive care unit (ICU) directly from the anesthetizing location, who have a documented use of a checklist or protocol for the transfer of care from the responsible anesthesia practitioner to the responsible ICU team or team member.

Rationale

The Agency for Healthcare Research and Quality (2015) found that "current signout mechanisms are generally ad-hoc, varying from hospital to hospital and unit to unit". According to data published by the Joint Commission, communication errors were indicated in 59% of reported sentinel events in 2012 and in 54% of operative/postoperative complications between 2004 and 2012. A 2006 survey among residents at Massachusetts General Hospital found that 59% of respondents reported one or more patients experiencing harm as a result of ineffective patient handoff practices during their most recent clinical rotation (Kitch et al., 2008). Therefore, a standardized transfer of care protocol or handoff tool/checklist that is utilized for all patients directly admitted to the intensive care unit (ICU) after undergoing a procedure under the care of an anesthesia practitioner will facilitate effective communications between the medical practitioner who provided anesthesia during the procedure and the care practitioner in the ICU who is responsible for post-procedural care. This should minimize errors and oversights in medical care of ICU patients after procedures.

Clinical Recommendation Statements:

The National Quality Forum, in its Preferred Practices and Performance Measures for Measuring and Reporting Care Coordination report (2010), recommends:

Preferred Practice 23: Healthcare providers and healthcare organizations should implement protocols and policies for a standardized approach to all transitions of care. Policies and procedures related to transitions and the critical aspects should be included in the standardized approach.

Evidence for Rationale

Agency for Healthcare Research and Quality (AHRQ). Patient safety primer: handoffs and signouts. [internet]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); [accessed 2015 Jul 30].

American Society of Anesthesiologists (ASA). Post-anesthetic transfer of care: use of checklist or protocol for direct transfer of care from procedure room to intensive care unit (ICU). Schaumburg (IL): American Society of Anesthesiologists (ASA); 2015 Oct 1. 2 p.

Kitch BT, Cooper JB, Zapol WM, Marder JE, Karson A, Hutter M, Campbell EG. Handoffs causing patient harm: a survey of medical and surgical house staff. Jt Comm J Qual Patient Saf. 2008 Oct;34(10):563-70. PubMed External Web Site Policy

National Quality Forum (NQF). Preferred practices and performance measures for measuring and reporting care coordination: a consensus report. Washington (DC): National Quality Forum (NQF); 2010.

Primary Health Components

Perioperative care; anesthesia; transfer of care; protocol or checklist

Denominator Description

All patients, regardless of age, who undergo any procedure including surgical, therapeutic or diagnostic procedure under anesthesia and are admitted to an intensive care unit (ICU) directly from the anesthetizing location

Numerator Description

Patients who have a documented use of a checklist or protocol for the transfer of care from the responsible anesthesia practitioner to the responsible intensive care unit (ICU) team or team member (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Care coordination

Internal quality improvement

Pay-for-reporting

Public reporting

Measurement Setting

Hospital Inpatient

Intensive Care Units

Transition

Type of Care Coordination

Coordination within a provider team/site

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Does not apply to this measure

Target Population Age

All ages

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Effective Communication and Care Coordination
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Diagnostic Evaluation

Institutionalization

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients, regardless of age, who undergo any procedure including surgical, therapeutic or diagnostic procedure under anesthesia and are admitted to an intensive care unit (ICU) directly from the anesthetizing location

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Patients who have a documented use of a checklist or protocol for the transfer of care from the responsible anesthesia practitioner to the responsible intensive care unit (ICU) team or team member

Note:

  • The key handoff elements that must be included in the transfer of care protocol or checklist include:
    1. Identification of patient, key family member(s) or patient surrogate
    2. Identification of responsible practitioner (primary service)
    3. Discussion of pertinent medical history
    4. Discussion of the surgical/procedure course (procedure, reason for surgery, procedure performed)
    5. Intraoperative anesthetic management and issue/concerns to include things such as airway, hemodynamic, narcotic, sedation level and paralytic management and intravenous fluids/blood products and urine output during the procedure
    6. Expectations/Plans for the early post-procedure period to include things such as the anticipated course (anticipatory guidance), complications, need for laboratory or electrocardiogram (ECG) and medication administration
    7. Opportunity for questions and acknowledgement of understanding of report from the receiving ICU team
  • Identification of Patient: In the instance the identity of the patient is unable to be confirmed, identification provided by the clinical facility would suffice toward meeting performance of the measure.

Exclusions
Unspecified

Numerator Search Strategy

Institutionalization

Data Source

Administrative clinical data

Registry data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Post-anesthetic transfer of care: use of checklist or protocol for direct transfer of care from procedure room to intensive care unit (ICU).

Measure Collection Name

Perioperative Care

Submitter

American Society of Anesthesiologists - Medical Specialty Society

Developer

American Society of Anesthesiologists - Medical Specialty Society

Physician Consortium for Performance Improvement® - Clinical Specialty Collaboration

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Work Group Members

Alexander A. Hannenberg, MD (Co-chair); Andrew J. Patterson, MD, PhD (Co-chair); William R. Andrews, MD, MS; Rebecca A. Aslakson, MD, PhD; Daniel R. Brown, MD, PhD; Neal H. Cohen, MD, MPH, MS; Peggy Duke, MD; Heidi L. Frankel, MD; Lorraine M. Jordan, BSN, MS, PhD; Jeremy M. Kahn, MD, MS; Jason N. Katz, MD, MHS; Gerald A. Maccioli, MD; Catherine L. Scholl, MD; Todd L. Slesinger, MD; Victoria M. Steelman, PhD, RN; Avery Tung, MD

Work Group Staff

Meredith Herzog, American Board of Medical Specialties; Maureen Amos, American Society of Anesthesiologists; Mark Antman, DDS, MBA, American Medical Association; Elvia Chavarria, MPH, American Medical Association; Jodie Dvorkin, MD, MPH, American Medical Association; Kendra Hanley, MS, American Medical Association; Jennifer Heffernan, MPH, American Medical Association; Toni Kaye, MPH, American Medical Association; Kimberly Smuk, RHIA, American Medical Association; Elvira L. Ryan, MBA, BSN, RN, The Joint Commission

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Measure Initiative(s)

Physician Quality Reporting System

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 Oct

Measure Maintenance

Annually

Date of Next Anticipated Revision

2016 Nov

Measure Status

This is the current release of the measure.

Source(s)

American Society of Anesthesiologists (ASA). Post-anesthetic transfer of care: use of checklist or protocol for direct transfer of care from procedure room to intensive care unit (ICU). Schaumburg (IL): American Society of Anesthesiologists (ASA); 2015 Oct 1. 2 p.

Measure Availability

Source available from the American Society of Anesthesiologists (ASA) Web site External Web Site Policy.

For more information, contact ASA at 1061 American Lane Schaumburg, IL 60173-4973; Phone: 847-825-5586; Fax: 847-825-1692; E-mail: info@asahq.org; Web site: asahq.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on March 23, 2016. The information was verified by the measure developer on April 26, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

For more information, please contact the American Society of Anesthesiologists (ASA) for downloading, use and reproduction at (847) 825-5589 or (202) 289-2222.

The Measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications.

The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain.

Commercial uses of the Measures require a license agreement between the user and the American Medical Association (AMA), [on behalf of the Physician Consortium for Performance Improvement® (PCPI®)] or American Society of Anesthesiologists (ASA). Neither the AMA, ASA, PCPI, nor its members shall be responsible for any use of the Measures.

The AMA's, PCPI's and National Committee for Quality Assurance's significant past efforts and contributions to the development and updating of the Measures is acknowledged. ASA is solely responsible for the review and enhancement ("Maintenance") of the Measures as of May 23, 2014. ASA encourages use of the Measures by other health care professionals, where appropriate.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

© 2014 American Medical Association and American Society of Anesthesiologists. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, ASA, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT®) or other coding contained in the specifications.

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