Measure Abbreviation
TEMP-03
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
Outcome
Description

Percentage of patients, regardless of age, who undergo surgical or therapeutic procedures under general or neuraxial anesthesia of 60 minutes duration or longer for whom at least one body temperature greater than or equal to 36 degrees Celsius (or 96.8 degrees Fahrenheit) was recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time

Measure Time Period

Case start to case end

Inclusions
  • All patients, regardless of age, who undergo surgical or therapeutic procedures under general or neuraxial anesthesia of 60 minutes duration or longer.
Exclusions
  • Cases <60 minutes duration between anesthesia start and anesthesia end.
  • MAC cases
  • Peripheral Nerve Block only cases
  • Radical clavicle or scapula surgery (CPT: 00452)
  • Thoracolumbar sympathectomy (CPT: 00622)
  • Lumbar chemonucleolysis (CPT: 00634)
  • Diagnostic arteriography/venography (CPT: 01916)
  • Organ harvest (CPT: 01990)
  • Anesthesia for diagnostic or therapeutic nerve blocks/injections (CPT: 01991, 01992)
  • Other anesthesia procedure (CPT: 01999)
  • Cardiac surgery (CPT: 00561, 00562, 00563, 00566, 00567, 00580, 01920)
  • Obstetric Operative Procedures (CPT: 01968, 01969)
  • Acute Pain Management (CPT: 01996)
  • Obstetric Non-Operative Procedures (CPT: 01958, 01960, 01967)
  • Obstetric Non-Operative Procedures with procedure text: “Labor Epidural”
  • Cases with an intraoperative note mapped to intentional hypothermia (MPOG concept: 50037)
  • Emergency cases (MPOG concepts: 70142 or 515)
Success

At least one body temperature measurement equal to or greater than 36 degrees Celsius (or 96.8 degrees Fahrenheit) achieved within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time.

Other Measure Build Details

Temperature documented in within the postop vital sign note in the anesthetic record or temperatures documented and mapped to the temperature physiologic concepts are acceptable sources for this measure. Conversion from F to C:    F=32 +9/5 (°C)

For sites that do not contribute PACU data to ASPIRE, this measure will only capture data documented by the anesthesia provider on the intraoperative anesthetic record.

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

Algorithm for determining Case Duration:

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.
Responsible Provider

Provider present for longest duration of the case per staff role. See ‘Other Measure Build Details’ section of this specification to view the algorithm used for determining case duration.

In the event that two or more providers in the same class are signed in for the same duration, all providers signed in for the longest duration will be attributed.

Threshold
<10%
MPOG Concept IDs Required

Temperature MPOG Concept IDs

Exclusion MPOG Concept IDs

3050

Temp 1- Unspecified Site

50037

Intentional hypothermia

3051

Temp 2- Unspecified Site

70142

Assessment and Plan-Emergent Status

3052

Temp 1- Monitoring Site

 

3053

Temp 2- Monitoring Site

 

3031

Temperature- Temporal Artery

 

3054

Temperature- Skin

 

3055

Temperature- Esophageal

 

3056

Temperature- Blood

 

3057

Temperature- Tympanic

 

3058

Temperature- Bladder

 

3059

Temperature- Nasopharyngeal

 

3060

Temperature- Axillary

 

3061

Temperature- Rectal

 

50174

Postoperative vital signs

 

Data Diagnostics Affected
  • Cases with a Temperature Observation
  • Cases with Staff Tracking
  • Staff Role Mapping
  • Staff Sign-Ins are Timed
Rationale

Perioperative hypothermia is defined as a core temperature less than 36 degrees Celsius by both the National Institute of Health and Clinical Excellence and the American Heart Association.1,2 It is not uncommon for a patient’s core temperature to drop during surgery due to anesthetic induced peripheral vasodilation, exposure of skin during the surgical prep or impaired heat distribution. Pediatric patients are more likely to develop perioperative hypothermia due to a high surface area to weight ratio, minimal subcutaneous fat and inability to regulate their own temperature.3 Perioperative hypothermia can result in multiple adverse effects including surgical site infections, cardiovascular events, impaired wound healing and increased hospital length of stay. Such adverse effects are prevented through maintenance of normothermia intraoperatively.4-9

Risk Adjustment

Not applicable.

References

1.            Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Journal of the American College of Cardiology. 2014;64(22):e77-137.

2.            National Collaborating Centre for N, Supportive C. National Institute for Health and Clinical Excellence: Guidance. The Management of Inadvertent Perioperative Hypothermia in Adults. London: Royal College of Nursing (UK)National Collaborating Centre for Nursing and Supportive Care.; 2008.

3.            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.

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

5.            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.

6.            Carpenter L, Baysinger CL. Maintaining perioperative normothermia in the patient undergoing cesarean delivery. Obstetrical & gynecological survey. 2012;67(7):436-446.

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

8.            Horn EP, Schroeder F, Gottschalk A, et al. Active warming during cesarean delivery. Anesthesia and analgesia. 2002;94(2):409-414, table of contents.

9.            Yi J, Liang H, Song R, Xia H, Huang Y. Maintaining intraoperative normothermia reduces blood loss in patients undergoing major operations: a pilot randomized controlled clinical trial. BMC anesthesiology. 2018;18(1):126.