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## Complete Summary

#### TITLE

Anesthesiology and critical care: percentage of patients, regardless of
age, undergoing surgical or therapeutic procedures under general or
neuraxial anesthesia of 60 minutes duration or longer for whom *either*
active warming was used intraoperatively for the purpose of maintaining
normothermia, OR at least one body temperature equal to or greater than
36 degrees Centigrade (or 96.8 degrees Fahrenheit) was recorded within
30 minutes immediately before or the 15 minutes immediately after
anesthesia end time.

#### SOURCE(S)

American Society of Anesthesiologists, Physician Consortium for
Performance Improvement®. Anesthesiology and critical care physician
performance measurement set. Chicago (IL): American Medical Association;
2007 Oct. 21 p. \[5 references\]

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of patients, regardless of
age, undergoing surgical or therapeutic procedures under general or
neuraxial anesthesia of 60 minutes duration or longer for whom *either*
active warming was used intraoperatively for the purpose of maintaining
normothermia, OR at least one body temperature equal to or greater than
36 degrees Centigrade (or 96.8 degrees Fahrenheit) was recorded within
the 30 minutes immediately before or the 15 minutes immediately after
anesthesia end time.

#### RATIONALE

Anesthetic-induced impairment of thermoregulatory control is the primary
cause of perioperative hypothermia. Even mild hypothermia (1-2 degrees
Centigrade below normal) has been associated in randomized trials with a
number of adverse consequences, including: increased susceptibility to
infection, impaired coagulation and increased transfusion requirements,
cardiovascular stress and cardiac complications, post-anesthetic
shivering and thermal discomfort. Several methods to maintain
normothermia are available to the anesthesiologist in the perioperative
period; various studies have demonstrated the superior efficacy of
forced-air warming and warm water garments\*.

\*The following clinical recommendation statements are quoted
[verbatim]{.underline} from the referenced clinical guidelines and
represent the evidence base for the measure:

[Preoperative Patient Management]{.underline}

[Assessment]{.underline}: Identify patient\'s risk factors for unplanned
perioperative hypothermia. Measure patient temperature on admission.
Determine patient\'s thermal comfort level (ask the patients if they are
cold). Assess for other signs and symptoms of hypothermia (shivering,
piloerection, and/or cold extremities).

[Interventions]{.underline}: Institute preventive warming measures for
patients who are normothermic (normothermia is defined as a core
temperature range from 36 degrees Centigrade to 38 degrees Centigrade
\[96.8 degrees Fahrenheit to 100.4 degrees Fahrenheit\]). A variety of
measures may be used, unless contraindicated. Passive insulation may
include warmed cotton blankets, socks, head covering, limited skin
exposure, circulating water mattresses, and increase in ambient room
temperature (minimum 68 degrees Fahrenheit to 75 degrees Fahrenheit).
Institute active warming measures for patients who are hypothermic
(defined as a core temperature less than 36 degrees Centigrade). Active
warming is the application of a forced air convection warming system.
Apply appropriate passive insulation and increase the ambient room
temperature (minimum 68 degrees Fahrenheit to 75 degrees Fahrenheit).
Consider warmed intravenous (IV) fluids. (American Society of
PeriAnesthesia Nurses \[ASPAN\])

[Intraoperative Patient Management]{.underline}

[Assessment]{.underline}: Identify patient\'s risk factors for unplanned
perioperative hypothermia. Determine patient\'s thermal comfort level
(ask the patients if they are cold). Assess for other signs and symptoms
of hypothermia (shivering, piloerection, and/or cold extremities).
Monitor patient\'s temperature intraoperatively.

[Intervention]{.underline}: Implement warming methods. (ASPAN)

Maintenance of body temperature in a normothermic range is recommended
for most procedures other than during periods in which mild hypothermia
is intended to provide organ protection (e.g., during high aortic
cross-clamping). (American College of Cardiology/American Heart
Association \[ACC/AHA\])

#### PRIMARY CLINICAL COMPONENT

Perioperative temperature management; active warming; forced are
warming; warm water garments; body temperature

#### DENOMINATOR DESCRIPTION

All patients, regardless of age, undergoing surgical or therapeutic
procedures under general or neuraxial anesthesia of 60 minutes duration
or longer (see the related \"Denominator Inclusions/Exclusions\" field
in the Complete Summary)

#### NUMERATOR DESCRIPTION

Patients for whom *either*:

-   active warming\* was used intraoperatively for the purpose of
    maintaining normothermia, OR

-   at least one body temperature equal to or greater than 36 degrees
    Centigrade (or 96.8 degrees Fahrenheit) was recorded within the 30
    minutes immediately before or the 15 minutes immediately after
    anesthesia end time

\***Note**: For purposes of this measure, \"active warming\" is limited
to the following modalities only: forced-air warming, warm water
garments.

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Unspecified

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Hospitals

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Individual Clinicians

#### TARGET POPULATION AGE

All patients regardless of age

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

All patients, regardless of age, undergoing surgical or therapeutic
procedures under general or neuraxial anesthesia of 60 minutes duration
or longer

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All patients, regardless of age, undergoing surgical or therapeutic
procedures under general or neuraxial anesthesia of 60 minutes duration
or longer

**Exclusions**\
Documentation of one of the following medical reason(s) for not using
active warming intraoperatively for the purpose of maintaining
normothermia OR achieving at least one body temperature equal to or
greater than 36 degrees Centigrade (or 96.8 degrees Fahrenheit) recorded
within the 30 minutes immediately before or the 15 minutes immediately
after anesthesia end time:

-   intentional hypothermia

-   not indicated due to anesthetic technique: peripheral nerve block
    without general anesthesia, OR monitored anesthesia care

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Therapeutic Intervention

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients for whom *either*:

-   active warming\* was used intraoperatively for the purpose of
    maintaining normothermia, OR

-   at least one body temperature equal to or greater than 36 degrees
    Centigrade (or 96.8 degrees Fahrenheit) was recorded within the 30
    minutes immediately before or the 15 minutes immediately after
    anesthesia end time

\***Note**: For purposes of this measure, \"active warming\" is limited
to the following modalities only: forced-air warming, warm water
garments.

**Exclusions**\
None

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Episode of care

#### DATA SOURCE

Administrative data\
Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Measure #3: perioperative temperature management.

#### MEASURE COLLECTION

[The Physician Consortium for Performance Improvement® Measurement
Sets](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1996&doc=178)

#### MEASURE SET NAME

[Anesthesiology and Critical Care Physician Performance Measurement
Set](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1996&doc=11472)

#### SUBMITTER

American Medical Association on behalf of the American Society of
Anesthesiologists and the Physician Consortium for Performance
Improvement®

#### DEVELOPER

American Society of Anesthesiologists\
Physician Consortium for Performance Improvement®

#### FUNDING SOURCE(S)

Unspecified

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

Alex A. Hannenberg, MD (*Co-Chair*); Jinnet Fowles, PhD (*Co-Chair*);
Neal Cohen, MD, MPH, MS; Richard T. Connis, PhD; Todd Dorman, MD; Thomas
Esposito, MD, MPH, FACS; Ronald A. Gabel, MD; Michael Heisler, MD, MPH;
Cynthia P. Helstad, PhD, RN; Daniel L. Herr, MS, MD, FCCM; Kay Jewell,
MD, ABHM; Gerald A. Maccioli MD, FCCM; David G. Nickinovich, PhD; Mark
D. Morasch, MD; William P. Schecter, MD FACS; Daniel Sessler, MD; Lisa
J. Thiemann, CRNA, MNA; Patrick E. Voight, RN, BSN, MSA, CNOR

Karin Bierstein, JD, MPH, American Society of Anesthesiologists

Mark Antman, DDS, MBA, American Medical Association; Joseph Y. Gave,
MPH, American Medical Association; Kendra Hanley, MS, CHE, American
Medical Association; Karen S. Kmetik, PhD, American Medical Association

Rebecca A. Kresowik, Facilitator; Timothy F. Kresowik, MD, Facilitator

Phil Renner, MBA, National Committee for Quality Assurance

Lisa Buczkowski, RN, MS, Joint Commission on Accreditation of Healthcare
Organizations; Elvira Ryan, RN, Joint Commission on Accreditation of
Healthcare Organizations

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

Conflicts, if any, are disclosed in accordance with the Physician
Consortium for Performance Improvement® conflict of interest policy.

#### ENDORSER

National Quality Forum

#### INCLUDED IN

Ambulatory Care Quality Alliance

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2007 Oct

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

American Society of Anesthesiologists, Physician Consortium for
Performance Improvement®. Anesthesiology and critical care physician
performance measurement set. Chicago (IL): American Medical Association;
2007 Oct. 21 p. \[5 references\]

#### MEASURE AVAILABILITY

The individual measure, \"Measure #3: Perioperative Temperature
Management,\" is published in the \"Anesthesiology and Critical Care
Physician Performance Measurement Set.\" This document and technical
specifications are available in Portable Document Format (PDF) from the
American Medical Association (AMA)-convened Physician Consortium for
Performance Improvement® Web site:
[www.physicianconsortium.org](http://www.physicianconsortium.org/).

For further information, please contact AMA staff by e-mail at
<cqi@ama-assn.org>.

#### NQMC STATUS

This NQMC summary was completed by ECRI Institute on January 2, 2008.
The information was verified by the measure developer on January 11,
2008.

#### COPYRIGHT STATEMENT

© 2007 American Medical Association. All Rights Reserved.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/10/2008