Measure Abbreviation
TEMP-01
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 that active warming was administered by the anesthesia provider.

Measure Time Period

Anesthesia Start to Patient Extubated

Inclusions

Cases with general or neuraxial anesthetic technique.

Exclusions
  • ASA 5 and 6 cases
  • Diagnostic Procedures (CPT: 01922)
  • Obstetric Non-Operative Procedures (CPT: 01958, 01960, 01967)
  • Obstetric Non-Operative Procedures with procedure text: “Labor Epidural”
  • 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
  • Cases less than 60 minutes between Case Start and Case End.
    • Algorithm for determining Case Length:
      • Case Start
      1. Anesthesia Induction End.  If not available, then
      2. Anesthesia Induction Begin.  If not available, then
      3. Procedure Start. If not available, then
      4. Patient in Room.  If not available, then
      5. Anesthesia Start
      • Case End
      1. Patient Extubated.  If not available, then
      2. Procedure End.  If not available, then
      3. Patient Out of Room.  If not available, then
      4. Anesthesia End
Success
  • 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.
    • Case End
    1. Patient Extubated.  If not available, then
    2. Procedure End.  If not available, then
    3. Patient Out of Room.  If not available, then
    4. Anesthesia End
  • Other considerations:
    • For patients undergoing cesarean section (CPT: 01961, 01962, 01963, 01968, 01969), fluid warmer is accepted as an active warming device.
Other Measure Build Details
  • 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.
Responsible Provider

Provider present at induction end.

Threshold
90%
MPOG Concept IDs Required

Temperature MPOG Concept IDs

Case Time MPOG Concept IDs

3050

Temp 1- Unspecified Site

50002

AACD Anesthesia Start Date/Time

3051

Temp 2- Unspecified Site

50003

AACD Patient in Room Date/Time

3052

Temp 1- Monitoring Site

50004

AACD Induction Start Date/Time

3053

Temp 2- Monitoring Site

50005

AACD Induction End Date/Time

3031

Temperature- Temporal Artery

50006

AACD Procedure Start Date/Time

3054

Temperature- Skin

50007

AACD Procedure Finish Date/Time

3055

Temperature- Esophageal

50008

AACD Patient out of room Date/Time

3056

Temperature- Blood

50009

AACD Anesthesia End Date/Time

3057

Temperature- Tympanic

Extubation MPOG Concept IDs

3058

Temperature- Bladder

50127

Intubation Extubated Awake or Deep

3059

Temperature- Nasopharyngeal

50145

Laryngeal Mask Airway removed Deep or Awake

3060

Temperature- Axillary

50202

Emergence- Patient Extubated

3061

Temperature- Rectal

 

3062

Temperature- Myocardial

 

3533

Temperature Route

 

50191

Monitoring- Temperature Probe Placed

 

50192

Monitoring- Temperature Probe Location/Type

 

Warming Method Concept IDs

 

50138

Patient Warming Method- Convective Warmer

 

50320

Warming Attempts- Warm Room

 

50321

Warming Attempts- Convective Warmer

 

50322

Warming Attempts- Warm Blanket

 

50323

Warming Attempts- Radiant Heaters

 

50324

Warming Attempts- Fluid Warmer

 

50325

Warming Attempts- Warmer or blankets location detail

 

Data Diagnostics Affected
  • Percentage of Cases with a Temperature Observation
  • Percentage of Cases with an Extubation Note
  • Percentage of Cases with Anesthesia Induction End Documented
  • Percentage of General and Neuraxial Cases with Warming Method Specified
Rationale

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

Risk Adjustment

Not applicable.

References

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.