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  • Measure Summary
  • NQMC:010657
  • Oct 2015
  • NQF-Endorsed Measure

Perioperative care: percentage of patients, regardless of age, who undergo surgical or therapeutic procedures under general or neuraxial anesthesia of 60 minutes duration or longer for whom at least one body temperature greater than or equal to 35.5 degrees Celsius (or 95.9 degrees Fahrenheit) was recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time.

American Society of Anesthesiologists (ASA). Perioperative temperature management (outcome). Schaumburg (IL): American Society of Anesthesiologists (ASA); 2015 Oct 1. 3 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: Outcome

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 surgical or therapeutic procedures under general or neuraxial anesthesia of 60 minutes duration or longer for whom at least one body temperature greater than or equal to 35.5 degrees Celsius (or 95.9 degrees Fahrenheit) was recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time.

Rationale

A drop in core temperature during surgery, known as perioperative hypothermia, can result in numerous adverse effects, which can include adverse myocardial outcomes, subcutaneous vasoconstriction, increased incidence of surgical site infection, and impaired healing of wounds (Hannan et al., 2010). The desired outcome, reduction in adverse surgical effects due to perioperative hypothermia, is affected by maintenance of normothermia during surgery.

Unintended perioperative hypothermia occurs in up to 20% of surgical patients (Hart et al., 2011). An observational cohort study in a pediatric setting found that more than 50% of children experienced intraoperative hypothermia. Pediatric patients undergoing major surgery were at greater risk of intraoperative hypothermia (Pearce et al., 2010).

Clinical Recommendation Statements:

Preadmission/Preoperative Recommendations

Assessment: Assess for risk factors for perioperative hypothermia; measure patient temperature on admission; determine patient's thermal comfort level; assess for signs and symptoms of hypothermia; document and communicate all risk factor assessment findings to all members of the anesthesia/surgical team.

Interventions: Implement passive thermal care measures; maintain ambient room temperature at or above 24 degrees Celsius; institute active warming for patients who are hypothermic; consider preoperative warming to reduce the risk of intra/postoperative hypothermia.

Intraoperative Recommendations

Assessment: Identify patient's risk factors for unplanned preoperative hypothermia; frequent intraoperative temperature monitoring should be considered in all cases; assess for signs and symptoms of hypothermia; determine patient's thermal comfort level; document and communicate all risk factor assessment findings to all members of the anesthesia/surgical team.

Interventions: Limit skin exposure to lower ambient environmental temperatures; initiate passive warming measures; maintain ambient room temperature from 20-25 degrees Celsius based on Association of periOperative Registered Nurses (AORN) and architectural recommendations; patients undergoing a procedure with an anticipated anesthesia time greater than 30 minutes and/or who are hypothermic preoperatively, and/or patients at risk for hypothermia or at increased risk for suffering its complications – forced air warming should be implemented; there is evidence to suggest that alternative active warming measures may maintain normothermia when used alone or in combination with forced air warming. These warming measures include: warmed IV fluids, warmed irrigation fluids, circulating water garments, circulating water mattresses, radiant heat, gel pad surface warming, resistive heating (Hooper et al., 2010).

Maintenance of body temperature in a normothermic range is recommended for most procedures other than during periods in which mild hypothermia is intended to provide organ protection (e.g., during high aortic cross-clamping) (Fleisher et al., 2007).

Evidence for Rationale

American Society of Anesthesiologists (ASA). Perioperative temperature management (outcome). Schaumburg (IL): American Society of Anesthesiologists (ASA); 2015 Oct 1. 3 p.

Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, Wijeysundera DN, American College of Cardiology, American Heart Association. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014 Dec 9;64(22):e77-137. PubMed External Web Site Policy

Hannan EL, Samadashvili Z, Wechsler A, Jordan D, Lahey SJ, Culliford AT, Gold JP, Higgins RS, Smith CR. The relationship between perioperative temperature and adverse outcomes after off-pump coronary artery bypass graft surgery. J Thorac Cardiovasc Surg. 2010 Jun;139(6):1568-1575.e1. PubMed External Web Site Policy

Hart SR, Bordes B, Hart J, Corsino D, Harmon D. Unintended perioperative hypothermia. Ochsner J. 2011;11(3):259-70. PubMed External Web Site Policy

Hooper VD, Chard R, Clifford T, Fetzer S, Fossum S, Godden B, Martinez EA, Noble KA, O'Brien D, Odom-Forren J, Peterson C, Ross J, Wilson L, ASPAN. ASPAN's evidence-based clinical practice guideline for the promotion of perioperative normothermia: second edition. J Perianesth Nurs. 2010 Dec;25(6):346-65. PubMed External Web Site Policy

Pearce B, Christensen R, Voepel-Lewis T. Perioperative hypothermia in the pediatric population: prevalence, risk factors and outcomes. J Anesth Clin Res. 2010;1:102.

Primary Health Components

Perioperative care; general or neuraxial anesthesia; body temperature

Denominator Description

All patients, regardless of age, who undergo surgical or therapeutic procedures under general or neuraxial anesthesia of 60 minutes duration or longer (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Patients for whom at least one body temperature greater than or equal to 35.5 degrees Celsius (or 95.9 degrees Fahrenheit) was recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time

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

Dataset
The Anesthesia Quality Institute National Anesthesia Clinical Outcome Registry (NACOR) Public Use File was used to assess available data on the submitted outcome Perioperative Temperature Management measure and the measure's performance, as extracted according to the measure specifications, for 2010 to 2013.

For comparison on reliability, performance rates and other indicators of quality, The Anesthesia Quality Institute NACOR Public Use File was used to assess data on the process Perioperative Temperature Management measure (National Quality Forum [NQF] #0454/Physician Quality Reporting System [PQRS] #193).

Reliability
Reliability was calculated according to the methods outlined in a technical report prepared by J.L. Adams titled The Reliability of Provider Profiling: A Tutorial. In this context, reliability represents the ability of a measure to confidently distinguish the performance of one physician from another. As discussed in the report: "Conceptually, it is the ratio of signal to noise. The signal in this case is the proportion of variability in measured performance that can be explained by real differences in performance. There are 3 main drivers of reliability; sample size, differences between physicians, and measurement error." According to this approach, reliability is estimated with a beta-binomial model. The beta-binomial model is appropriate for measuring the reliability of pass/fail measures such as those proposed.

Reliability for the outcome Perioperative Temperature Management measure, as extracted from cases where a temperature was recorded and submitted to NACOR, reflects the limited number of cases and providers available to analyze. As cases and providers increase, the reliability of the measure is expected to increase as well. We expect, should this measure be endorsed by NQF and added to quality reporting programs, that the increase of provider data submission will impact the performance scores and improve measure reliability.

Validity
Face validity of the measure score as an indicator of quality was systematically assessed as follows. After the measure was fully specified, a group of experts was assembled to rate face validity. The experts included 23 physicians.

The developer provided the detailed measure specifications to the experts and asked them to rate their agreement with the following statement: The scores obtained from the measure as specified will provide an accurate reflection of quality and can be used to distinguish good from poor quality.

The rating scale had five levels (1 to 5) with the following narrative anchors: 1 = Disagree; 3 = Moderate Agreement; 5 = Agree

As additional data and information become available on this measure, the American Society of Anesthesiologists (ASA) intends to conduct further measure validity testing on this measure.

The results of the assessment of face validity indicate that an independent group of experts (different from those who advised on measure development) had high levels of agreement with the statement: "The scores obtained from the measure as specified will provide an accurate reflection of quality and can be used to distinguish good and poor quality."

Mean rating = (3.78 out of 5)

This measure was examined through a group of experts. Out of the 23 participants, 16 agreed that the scores from the measure as specified would provide an accurate reflection of quality and 4 disagreed.

Additional testing information, including results tables, may be found in the NQF submission form for this measure.

Evidence for Extent of Measure Testing

National Quality Forum (NQF) measure submission form: perioperative temperature management. Washington (DC): National Quality Forum (NQF); 2015 Jan 14. 34 p.

State of Use

Current routine use

Current Use

Internal quality improvement

Pay-for-reporting

Public reporting

Measurement Setting

Ambulatory Procedure/Imaging Center

Hospital Inpatient

Hospital Outpatient

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

Health and Well-being of Communities
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Staying Healthy

IOM Domain

Effectiveness

Timeliness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients, regardless of age, who undergo surgical or therapeutic procedures under general or neuraxial anesthesia of 60 minutes duration or longer

Note: The anesthesia time used for this measure should be the time recorded in the anesthesia record.

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Patients for whom at least one body temperature greater than or equal to 35.5 degrees Celsius (or 95.9 degrees Fahrenheit) was recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Registry data

Type of Health State

Physiologic Health State (Intermediate Outcome)

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

Perioperative temperature management (outcome).

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

Endorser

National Quality Forum

NQF Number

2681

Date of Endorsement

2015 Sep 3

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). Perioperative temperature management (outcome). Schaumburg (IL): American Society of Anesthesiologists (ASA); 2015 Oct 1. 3 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.

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

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