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

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.

Anesthesia Start to Anesthesia End (See 'Other Measure Build Details' for more information.)

Adult patients requiring anesthesia

• ASA 5 & 6 inlcuding Organ Procurement (CPT: 01990)
• Procedures:
  • Block (Only) Procedures
  • Labor Epidurals (determined by the Obstetric Anesthesia Type value value codes: 3 & 6) including obstetric non-operative procedures (CPT: 01958)
  • MRI only procedures 

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

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:

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.

For cesarean delivery cases converted from labor epidural (as determined by Obstetric Anesthesia Type value code:1): Cesarean Delivery Start Time is used as the 'Measure Start Time'.

Measure End: Anesthesia End

*This measure will include valid MPOG cases defined by the Is Valid Case phenotype.

Not applicable

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

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.