Measure Abbreviation
TOC-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 patients, regardless of age, who are under the care of an anesthesia practitioner and are admitted to a PACU in which a post-anesthetic formal transfer of care protocol or checklist which includes the key transfer of care elements is utilized.

Measure Time Period

Anesthesia start to Anesthesia End

Inclusions
  • All patients, regardless of age, who are cared for by an anesthesia practitioner AND directly transferred from the anesthetizing location to PACU or other non-ICU location after the procedure where a transfer of care occurs.
Exclusions
  • Patients not transferred directly to a PACU or other non-ICU location (i.e. ICU transfers)
  • Cardiac surgery (CPT: 00561, 00562, 00563, 00567, 00580, 01920)
  • Obstetric Operative Procedures (CPT: 01968, 01969)
  • Acute Pain Management (CPT: 01996)
  • Radical clavicle or scapula surgery (CPT: 00452)
  • Thoracolumbar sympathectomy (CPT: 00622)
  • Lumbar chemonucleolysis (CPT: 00634)
  • Diagnostic arteriography/venography (CPT: 01916)
  • Burn debridement/grafting for 9% TBSA (CPT: 01953)
  • Organ harvest (CPT: 01990)
  • Anesthesia for diagnostic or therapeutic nerve blocks/injections (CPT: 01991, 01992)
  • Other anesthesia procedure (CPT: 01999)
  • Labor Epidurals (CPT: 01967)
  • Obstetric Non-Operative Procedures with procedure text: “Labor Epidural”
Success

A transfer of care protocol or handoff tool/checklist that includes the key handoff elements is used.

Other Measure Build Details

The percentage of handoffs will be calculated as number of handoffs documented as “yes” in the electronic anesthesia record where the denominator equals the number of direct transfer to PACU events.

The key handoff elements that must be included in the transfer of care protocol or checklist include:

  1. Identification of patient
  2. Identification of responsible practitioner (PACU nurse or advanced practitioner)
  3. Discussion of pertinent medical history
  4. Discussion of surgical/procedure course (procedure, reason for surgery, procedure performed)
  5. Intraoperative anesthetic management and issue/concerns
  6. Expectations/Plans for the early post-procedure period
  7. Opportunity for questions and acknowledgement of understanding of report form the receiving PACU team

Identification of patient- In the instance the identity of the patient is unable to be confirmed, identification provided by the clinical faculty would suffice toward meeting performance of the measure.

MPOG sites interested in auditing the transfer of care process can utilize the PACU Handoff Form available through the MQUARK application. More information regarding the MQUARK audit application is available on the MPOG website: https://mpog.org/apps/

Responsible Provider

Anesthesia provider in the room providing care at Anesthesia End

Method for determining Responsible Provider:

  1. CRNA attributed if both a CRNA and anesthesiologist are signed in. If CRNA not signed in, Attending anesthesiologist will be attributed.
  2. Resident if both a resident and attending anesthesiologist are signed in. If Resident not signed in, Attending anesthesiologist will be attributed.
Threshold
90%
MPOG Concept IDs Required

Postop Location MPOG Concept IDs

Handoff MPOG Concept IDs

50066

Phase I Recovery Room In Date/Time

50623

 Compliance- PACU/ICU Handoff of care performed, report given.

50067

Phase I Recovery Room Out Date/Time

 

50068

Phase II Recovery Room In Date/Time

 

50069

Phase II Recovery Room Out Date/Time

 

50070

Phase III Recovery Room In Date/Time

 

50071

Phase III Recovery Room Out Date/Time

 

50008

AACD Patient Out of Room Date/Time

 

50010

AACD Recovery Room In Date/Time

 

50706

Categorized Note – Postoperative Recovery

 

50734

Emergence – Patient Recovery Location

 

Data Diagnostics Affected
  • Cases with Staff Tracking
  • Staff Role Mapping
  • Staff Sign-Ins are Timed
  • Pro Fee Procedures
Rationale

Lack of communication or miscommunication between anesthesia providers and perioperative nurses can lead to patient harm.1,2 The Anesthesia Patient Safety Foundation identified ‘Patient-related communication issues, handoffs, and transitions of care’ as one of the top twelve Perioperative Safety Priorities for the specialty in 2018.5 The Joint Commission cited communication error as the number one cause of all anesthesia related sentinel events reported between 2004-2015.  Because anesthesia providers routinely transfer patients from the operating room (OR) to the PACU, they are responsible for communicating important information regarding the patient’s history, intraoperative course, and plans for pain management during the recovery period. Literature suggests that the handover process is more effective in relaying this important information when supported by the use of a standardized checklist. 3-4

Risk Adjustment

Not applicable

References
  1. Arora V, Johnson J, Lovinger D, Humphrey HJ, Meltzer DO. Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis. Qual Saf Health Care. 2005;14(6):401-407.
  2. Segall N, Bonifacio AS, Schroeder RA, et al. Can we make postoperative patient handovers safer? A systematic review of the literature. Anesthesia and analgesia. 2012;115(1):102-115.
  3. Weinger MB, Slagle JM, Kuntz AH, et al. A Multimodal Intervention Improves Postanesthesia Care Unit Handovers. Anesthesia and analgesia. 2015;121(4):957-971.
  4. Petrovic MA, Martinez EA, Aboumatar H. Implementing a perioperative handoff tool to improve postprocedural patient transfers. Jt Comm J Qual Patient Saf. 2012;38(3):135-142.
  5. Lane-Fall M. APSF highlights 12 perioperative patient safety priorities. APSF Newsletter. 2018; 33(2):33-68.