Measure Abbreviation
TRAN-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 with a blood transfusion that have a hemoglobin or hematocrit value documented prior to transfusion. 

Measure Time Period

Up to 36 hours prior to the first transfusion during the case

Inclusions

All surgical patients receiving anesthetics who receive a transfusion of red blood cells.

Exclusions
  • Patients < 18 years of age
  • ASA 5 & 6
  • Cardiac Procedures
  • Massive Transfusion: Transfusion of 4 or more units of blood; 4 hours before Anesthesia Start to Anesthesia End.
    • Note for sites that document transfusions in ml instead of units: ASPIRE will default to 300ml/unit.
  • Massive Blood loss: EBL ≥ 2000 ml
  • Burn cases (CPT Codes 01951, 01952, 01953)
  • Labor Epidurals as determined by the MPOG 'Obsteric Anesthesia Type' phenotype results 'Labor Epidural' and 'Conversion (Labor Epidural Portion)'
  • Obstetric Non-Operative Procedures - CPT 01958
  • Exclude patients with an EBL > 1500cc during cesarean section as determined by MPOG ‘Obstetric Anesthesia Type’ phenotype results:
    • ‘Cesarean Delivery’
    • ‘Cesarean Hysterectomy’
    • ‘Conversion (Cesarean Delivery portion)’
    • ‘Conversion (Cesarean Hysterectomy portion)’
    • 'Conversion (Labor Epidural and Cesarean Delivery Combined)'
  • Exclude patients with a HR>110, SBP<85, DBP<45, or O2Sat <95% during cesarean section as determined by MPOG ‘Obstetric Anesthesia Type’ phenotype results:
    • ‘Cesarean Delivery’
    • ‘Cesarean Hysterectomy’
    • ‘Conversion (Cesarean Delivery portion)’
    • ‘Conversion (Cesarean Hysterectomy portion)’
    • 'Conversion (Labor Epidural and Cesarean Delivery Combined)'
  • Exclude postpartum hemorrhage cases (ICD-10 code: O72.0, O72.1, O72.2, O72.3)
  • Cases where the ‘Measure End Time’ precedes ‘Measure Start Time’ will be excluded and marked 'invalid'
Success
  • Documentation of hemoglobin and/or hematocrit within 90 minutes prior to blood transfusion
Other Measure Build Details
  • Considerations:
    • For the first unit of transfusion, a hemoglobin or hematocrit of any value should be checked in a time period of 0 to 90 minutes before the transfusion, or the most recent documented hemoglobin or hematocrit of less than 8/24 should be within 36 hours of the transfusion.
    • If the last hemoglobin or hematocrit drawn before the first transfusion is ≤ 5/16, a second unit could be administered without rechecking hemoglobin/hematocrit.
    • If multiple units are administered, documentation of a hemoglobin or hematocrit value must be present within 90 minutes before each administration.
  • Transfusion is defined as:
    • Packed Red Blood Cells-Autologous, Homologous, Unknown Type
    • Whole Blood-Homologous, Unknown Type                          
    • Categorized Note- Blood Products
  • Hematocrit/hemoglobin are defined as:
    • POC - Blood gas-Hct measured,  Hemoglobin
    • POC – Hematocrit spun
    • POC – Coulter counter – Hematocrit, Hemoglobin
    • Formal lab – Hematocrit,  Hemoglobin
    • Formal lab - Blood gas - Hct measured, Hemoglobin
Responsible Provider

Provider(s) who administered blood product

Threshold
90%
MPOG Concept IDs Required

Blood Product MPOG Concept IDs

Point of Care Testing MPOG Concept IDs

Formal Lab MPOG Concept IDs

EBL MPOG Concept ID

10489

Packed Red Blood Cells- Autologous

3415

POC-Blood gas-Hct measured

5005

Formal lab- Hemoglobin

10499

EBL

10490

Packed Red Blood Cells- Homologous

3435

POC- hematocrit spun

5006

Formal lab- Hematocrit

 

10492

Whole Blood- Homologous

3440

POC- Coulter counter- Hemoglobin

5038

Formal lab- Blood gas- Hct measured

 

10616

Packed Red Blood Cells- Unknown Type

3450

POC- Coulter counter- Hematocrit

5080

Formal lab- Blood gas- Hemoglobin

10617

Whole Blood- Unknown Type

5081

POC- Blood gas- Hemoglobin

10618

Categorized Note- Blood Products

Data Diagnostics Affected
  • Percentage of Inpatient Cases with Documented Blood Loss
  • Percentage of Cases with Documented Blood Transfusions
  • Percentage of Fluids with a Meaningful Fluid Mapping
  • Percentage of Labs Mapped to a Meaningful Lab Mapping
  • Percentage of Cases with a Lab Drawn During Anesthesia
  • Percentage of Cases with Point of Care Hematocrit Labs
  • Percentage of Cases with Point of Care Hemoglobin Labs
  • Percentage of Cases with any Staff Tracking
  • Percentage of Anesthesia Provider Sign-Ins that are Timed
Phenotypes Used
Rationale

The American Association of Blood Banks (AABB) recommends a transfusion threshold of hemoglobin concentration less than or equal to 8 g/dL or when patient is symptomatic (chest pain, orthostatic hypotension, tachcardia unresponsive to fluid resuscitation, or congestive heart failure).1,2 Furthermore, blood transfusions in non-cardiac surgery have been associated with increased risk of 30-day mortality and morbidity.3

Although the literature is not conclusive on the exact hemoglobin concentration that requires transfusion, the evidence is clear that use of fewer RBC transfusions reduces cost and risk for adverse effects of transfusion, and that transfusion for hemoglobin values greater than 10 g/dL is usually not indicated.

TRAN 01 is a process measure focused on measuring hemoglobin or hematocrit prior to transfusion. The rationale for this measure is that the decision to transfuse should include knowledge of the hemoglobin value before administration of blood.  Because the literature is not absolutely conclusive on a specific hemoglobin threshold for transfusion, TRAN 01 does not include the actual hemoglobin value as part of the measure.

Risk Adjustment

Not applicable

References

1. Carson JL, Grossman BJ, Kleinman S, et al. Red blood cell transfusion: a clinical practice guideline from the AABB*. Annals of internal medicine. 2012;157(1):49-58.

2. Carson JL, Guyatt G, Heddle NM, et al. Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage. Jama. 2016;316(19):2025-2035.

3. Glance LG, Dick AW, Mukamel DB, et al. Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology. 2011;114(2):283-292.