Measure Abbreviation
TEMP-04-Peds
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 < 18 years old who undergo any procedure greater than 30 minutes and have a Median core/near core body temperature > 36C (96.8F) 

Measure Time Period

Intraoperative

Inclusions

Patients < 18 years old who undergo any procedure including surgical, therapeutic, or diagnostic that requires general anesthesia.

Exclusions
  • ASA 5 and 6
  • Cases ≤ 30 minutes duration between measure start to measure end
  • Cases without a core or near core temperature route documented
  • Unlisted Anesthesia procedure (CPT: 01999)
  • Organ Harvest (CPT: 01990)
  • Obstetric Non-Operative Procedures (CPT: 01958, 01960, 01967)  
  • Cardiac Surgery (CPT: 00560, 00561, 00562, 00563, 00566, 00567, 00580)
  • Cases with MAC/Sedation Anesthesia Technique
  • 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
Success

The median core or near core temperature intraoperatively is not less than 36 degrees Celsius (96.8F) 

Other Measure Build Details

Algorithm for determining Measure Start/End Times

Measure Start Time

  1. Patient In Room. If not then, 
  2. Induction Start. If not then,
  3. Induction End. If not then, 
  4. Procedure Start. If not then,
  5. Anesthesia Start

Measure  End Time

  1. Patient Out of Room. If not then, 
  2. Procedure End. If not then
  3. Anesthesia End
  • Instances where there are two temperature monitoring methods, the average of both temperature values is used to determine the value for a single minute. 
  • Conversion from C to F: F= 32 +9/5 (°C) 

Artifact Logic:

  • Step 1: Exclude all Temperature values that are < 32C and > 40C
  • Step 2: Apply artifact to exclude minute-to-minute values ≥ 0.5 C difference in temperature.
    • Example: If Temp B at 0801 is ≥ 0.5 C higher or lower than Temp A at 0800, then exclude Temp B
  • Step 3: Exclude first 5 minutes of temperature monitoring to account for probe warming
    • minute-to-minute: exclude first 5 values
    • 5 minute intervals: exclude the first value
  • Step 4: Calculate Median of remaining temperature values 

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 the 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
90%
MPOG Concept IDs Required

Temperature MPOG Concept IDs

  • 3050   Temp 1 - Unspecified Site
  • 3051   Temp 2 - Unspecified Site
  • 3052   Temp 1 - Monitoring Site
  • 3053   Temp 2 - Monitoring Site
  • 3031   Temperature - Temporal Artery
  • 3055   Temperature - Esophageal
  • 3056   Temperature - Blood
  • 3057   Temperature - Tympanic
  • 3058   Temperature - Bladder
  • 3059   Temperature - Nasopharyngeal
  • 3060   Temperature - Axillary
  • 3061   Temperature - Rectal
  • 3533   Temperature Route
  • 50174 Postoperative Vital Signs
  • 50191 Monitoring - Temperature probe placed
  • 50192 Monitoring - Temperature probe location/type
Data Diagnostics Affected
  • Cases with an intraoperative temperature observation
  • Cases with a temperature route documented
  • Cases with Staf Tracking
  • Staff Role Mapping
  • Staff Sign-Ins are Timed
Rationale

Core temperatures outside the normal range pose significant risks to patients. 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. 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 and the inability to regulate their own temperature as nonshivering thermogenesis which is impaired by general anesthesia. 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.1-3

References
  1. Mutchnick I, Thatikunta M, Braun J, et al. Protocol-driven prevention of perioperative hypothermia in the pediatric neurosurgical population. J Neurosurg Pediatr. February 2020:1-7.
  2. Pearce B, Christensen R, Voepel-Lewis T. Perioperative Hypothermia in the Pediatric Population: Prevalence, Risk Factors and Outcomes. Journal of Anesthesia & Clinical Research. 2010;01(01). doi:10.4172/2155-6148.1000102
  3. Walker S, Amin R, Arca MJ, Datta A. Effects of Intraoperative Temperatures on Postoperative Infections in Infants and Neonates. J Pediatr Surg. October 2019. doi:10.1016/j.jpedsurg.2019.09.060