Percentage of patients with active warming applied.

General and neuraxial anesthesia causes vasodilation thus redistributing body heat from the core to peripheries.  This redistribution can cause hypothermia.  Core temperatures outside the normal range pose significant risks to patients. Pediatric patients are more likely to develop perioperative hypothermia due to a high surface area to weight ratio and inability to regulate their own temperature.¹  Published research has correlated impaired wound healing, adverse cardiac events, altered drug metabolism, and coagulopathies with unplanned perioperative hypothermia. These adverse outcomes resulted in prolonged hospital stays and increased healthcare expenditures.  Active warming techniques provide the best results for reducing cutaneous heat loss and preventing hypothermia.^2-7

Anesthesia Start to Patient Extubated

Patients receiving general or neuraxial anesthesia (determined by Anesthesia Technique: General value code > 0 and Anesthesia Technique: Neuraxial value code >0).

• ASA 5 & 6 including Organ Procurement (CPT: 01990)
• Cases < 60 minutes (see other measure build details)
• Procedures:
  • Cesarean Delivery Cases (determined by Obstetric Anesthesia Type value codes: 1, 2, 7)
  • Diagnostic Imaging Procedures (value code: 1)
  • Labor Epidurals (determined by the Obstetric Anesthesia Type value codes: 3 & 6 including obstetric non-operative procedures - CPT: 01958)

• Cases with documentation of an active warming device applied OR
• Cases with at least one temperature greater than or equal to 36.0°C within the 30 minutes before case end through case end. See 'Other Measure Build Details' section for definition of case end time.
• Other considerations:
  • For patients undergoing cesarean section (determined by Obstetric Anesthesia Type value codes: 1, 2, 7), Fluid warmer is accepted as an active warming device (determined by Warming Method Classification value code: 3).

The active warming (TEMP 01) measure will identify the percentage of cases in which an active warming device was applied between 'Case Start' and 'Case End' or the patient maintained a temperature above 36.0°C without active warming. In the event that active warming was not performed or documented, the case will meet the measure requirements if at least one temperature is greater than or equal to 36.0°C within 30 minutes of patient out of room.

Active warming is determined by Warming Method Classification value codes: 2, 4, 5, 96.

Active Warming includes:

• Convective warming: forced air
• Conductive warming: circulating water mattress, resistive heating electrical blankets
• Endovascular warming, using a heat exchanging catheter (very rarely used)
• Radiant heaters

Passive Warming interventions (NOT active warming):

• Increasing ambient room temperature
• Thermal insulators such as blankets
• Fluid warmer (except for cesarean section)

Algorithm for determining Case Duration for Exclusion Criteria (<60 minutes):

• Start
  • Patient In Room. If not available, then
  • Induction End. If not available, then
  • Anesthesia Start.
• End
  • Patient out of room. If not available, then
  • Anesthesia End.

Algorithm for determining Case End for 36.0°C Success Criterion:

• Latest Extubation Time. If not available or documented after Anesthesia End,
• Latest LMA Removal Time. If not available or documented after Anesthesia End,
• Surgery End. If not available,
• Patient In Room. If not available,
• Anesthesia End.

Temperature Artifact algorithm:

• Less than 32.0°C (89.6F)
• Greater than 40.0°C (104.0F)
• Any minute-to-minute jumps >0.5°C equivalent. 
  • Example: 0.125°C /15s, 0.25°C / 30s, 1°C / 2mins
• Conversion from F to C:    F=32 +9/5 (°C)
• If temperature site not present in physiologic concept, refer to intraop notes.
• This measure uses the Warming Method Clasification and Warming Method Notes, which are not time bound

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

Not applicable.

Provider(s) present at Induction End. If not available, then Patient in Room. If Patient in Room not available, then Anesthesia Start.

1. Carpenter L, Baysinger CL. Maintaining perioperative normothermia in the patient undergoing cesarean delivery. Obstetrical & gynecological survey. 2012;67(7):436-446.
2. Horn EP, Schroeder F, Gottschalk A, et al. Active warming during cesarean delivery. Anesthesia and analgesia. 2002;94(2):409-414, table of contents.
3. Insler SR, Sessler DI. Perioperative thermoregulation and temperature monitoring. Anesthesiology clinics. 2006;24(4):823-837.
4. Kim P, Taghon T, Fetzer M, Tobias JD. Perioperative hypothermia in the pediatric population: a quality improvement project. American journal of medical quality : the official journal of the American College of Medical Quality. 2013;28(5):400-406.
5. Madrid E, Urrutia G, Roque i Figuls M, et al. Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults. The Cochrane database of systematic reviews. 2016;4:Cd009016.
6. Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008;109(2):318-338.
7. Sun Z, Honar H, Sessler DI, et al. Intraoperative core temperature patterns, transfusion requirement, and hospital duration in patients warmed with forced air. Anesthesiology. 2015;122(2):276-285.