Measure Abbreviation
BP-02
Data Collection Method

This measure is calculated based on data extracted from the electronic medical record combined with administrative data sources such as professional fee and discharge diagnoses data.  This measure is explicitly not based on provider self-attestation.

Measure Type
Process
Description

Percentage of cases where gaps greater than 10 minutes in blood pressure monitoring are avoided.

Measure Time Period

Intraoperative. See ‘Other Measure Build Details’ for more information

Inclusions

All patients receiving anesthesia care by an anesthesiology provider, regardless of primary anesthesia technique.

Exclusions
  • ASA 5 and 6.
  • Obstetric Non-Operative Procedures (CPT: 01958, 01960, 01967) 
  • Obstetric Non-Operative Procedures with procedure text: “Labor Epidural”
  • Diagnostic Procedures (CPT: 01922)
  • MRI Rooms (Rooms tagged as Radiology-MRI)
  • MRI with procedure text:
    • MRI
    • MR Head
    • MR Brain
    • MR Chest
    • MR Torso
    • MR Abdomen
    • MR Lumbar
    • MR Spine
    • MR Knee
    • MR Femur
    • MR Abdomen
    • OFFSITE - RADIOLOGY PROCEDURE 
Success

Blood pressure monitoring with ≤10-minute gap in measurement interval.

Other Measure Build Details

BP 02 measures the avoidance of blood pressure monitoring gaps greater than ten minutes.  Timely blood pressure readings are an essential component of anesthesia vigilance. A measurement gap will be recorded for cases that have greater than ten minutes between consecutive blood pressure readings. The measure will capture non-invasive and invasive BP measurements.

Algorithm for determining Measure Start/End Times:

Measure Start Time:

First Blood Pressure Reading after the latest of these 3 times:

  1. First documented Anesthesia Start time.
  2. First documented Patient in Room time.
  3. First documented Data Capture Start time.

Measure End Time:

  1. Patient Out of Room. If not available,
  2. Data Capture End. If not available,
  3. Anesthesia End 
Responsible Provider

Individual signed into case at the 11th minute of identified measurement gap. Providers signed in for ≤ 10 minutes from the measure start time will be excluded.

Threshold
90%
MPOG Concept IDs Required

3011

BP Sys Invasive Unspecified Site 1

3040

BP Mean Arterial Line (Invasive, Peripheral)

3012

BP Dias Invasive Unspecified Site 1

3041

BP Sys Invasive Unspecified Site 2

3013

BP Mean Invasive Unspecified Site 1

3042

BP Dias Invasive Unspecified Site 2

3015

BP Sys Non-invasive

3043

BP Mean Invasive Unspecified Site 2

3020

BP Dias Non-invasive

3046

BP Sys Invasive Unspecified Site 3

3025

BP Mean Non-invasive

3047

BP Dias Invasive Unspecified Site 3

3026

BP Sys Invasive Unspecified Site 4

3048

BP Mean Invasive Unspecified Site 3

3027

BP Dias Invasive Unspecified Site 4

3475

BP Sys Invasive Unspecified Site 5

3028

BP Mean Invasive Unspecified Site 4

3476

BP Dias Invasive Unspecified Site 5

3030

BP Sys Arterial Line (Invasive, Peripheral)

3477

BP Mean Invasive Unspecified Site 5

3035

BP Dias Arterial Line (Invasive, Peripheral)

3041

BP Sys Invasive Unspecified Site 2

Data Diagnostics Affected
  • Percentage of Physiologic Observations with a Meaningful Type Mapping
  • Percentage of Cases with Invasive Blood Pressure
  • Percentage of Cases with Non-invasive Blood Pressure
  • Percentage of Cases with Physiologic Observations
  • Percentage of Physiologic Rows that are Machine Captured
  • Percentage of Cases with any Staff Tracking
  • Percentage of Anesthesia Provider Sign-Ins that are Timed
Rationale

The American Society of Anesthesiologist (ASA) standards for basic anesthetic monitoring includes an evaluation of blood pressure at least every five minutes in an effort to ensure adequate circulatory function during anesthesia. A retrospective study including 130,000 general anesthesia cases confirmed that blood pressure gaps greater than six and ten minutes are associated with a higher incidence of a patient transitioning into hypotension, leading to an increased risk of developing kidney or myocardial injury postoperatively. Extenuating circumstances where BP is not quantitatively measured every five minutes should be documented in the patient’s medical record.1-3

Hypotension is strongly associated with mortality, acute kidney injury, and myocardial ischemia.  The avoidance of hypotension requires the timely and frequent measurement of blood pressure.

Risk Adjustment

Not applicable

References
  1. Standards and Practice Parameters Committee. (2012). American Society of Anesthesiologists. Standards for basic anesthetic monitoring.
  2. Kruger GH, Shanks A, Kheterpal S, et al. Influence of non-invasive blood pressure measurement intervals on the occurrence of intra-operative hypotension. Journal of clinical monitoring and computing. 2018;32(4):699-705.
  3. Anesthesiologists. ASo. Standards for basic anesthetic monitoring. In: Anesthesiologists ASo, ed. Vol 4.2.22015.
  4. Bartels K, Esper SA, Thiele RH. Blood Pressure Monitoring for the Anesthesiologist: A Practical Review. Anesthesia and analgesia. 2016;122(6):1866-1879.