Measure Abbreviation
TEMP-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 with increased risk of hypothermia that the anesthesia provider documented at least one core temperature intraoperatively for any patient receiving a general anesthetic.

Measure Time Period

Anesthesia Start to Patient out of Room

Inclusions

All surgical patients receiving general anesthesia

Exclusions
  • ASA 5 and 6 cases
  • Cases with neuraxial anesthesia as the primary technique
  • Cases with regional anesthesia as the primary technique
  • 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
  • Cases ≤30 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 at least one core temperature documented between Anesthesia Start and Patient out of Room. If not available then, Anesthesia End.

Other Measure Build Details

Core or Near Core Temperature Monitoring Includes:

  • Pulmonary Artery Temperature
  • Distal Esophageal Temperature
  • Nasopharyngeal Temperature
  • Tympanic Membrane Temperature
  • Bladder Temperature
  • Rectal Temperature
  • Axillary Temperature (arm must be at patient side)
  • Oral Temperature

Peripheral Temperatures (not compliant):

  • Skin Temperature
  • Temporal Artery 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)

Note: If temperature site is not present in physiologic concept, will 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

3031

Temperature- Temporal Artery

50002

AACD Anesthesia Start Date/Time

3050

Temp 1- Unspecified Site

50003

AACD Patient in Room Date/Time

3051

Temp 2- Unspecified Site

50004

AACD Induction Start Date/Time

3052

Temp 1- Monitoring Site

50005

AACD Induction End Date/Time

3053

Temp 2- Monitoring Site

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

 

3058

Temperature- Bladder

 

3059

Temperature- Nasopharyngeal

 

3060

Temperature- Axillary

 

3061

Temperature- Rectal

 

3062

Temperature - Myocardial

 

3533

Temperature Route

 

50191

Monitoring- Temperature Probe Placed

 

50192

Monitoring- Temperature Probe Location/Type

 

50174

Postoperative Vital Signs

 

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 Cases with Temperature Location Documented
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. The mortality rate is almost 20% higher only monitoring skin temperature rather than a core temperature for those who experience malignant hyperthermia during surgery.2  Core temperature measurements are less variable than skin temperature measurements and more accurately represent body temperature.3-5

Risk Adjustment

Not applicable.

References

1.            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.

2.            Larach MG, Brandom BW, Allen GC, Gronert GA, Lehman EB. Malignant hyperthermia deaths related to inadequate temperature monitoring, 2007-2012: a report from the North American malignant hyperthermia registry of the malignant hyperthermia association of the United States. Anesthesia and analgesia. 2014;119(6):1359-1366.

3.            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.

4.            Insler SR, Sessler DI. Perioperative thermoregulation and temperature monitoring. Anesthesiology clinics. 2006;24(4):823-837.

5.            Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008;109(2):318-338.