Intraoperative Electronic Alerts Improve Compliance With National Quality Program Measure for Perioperative Temperature Management

Abstract

BACKGROUND: Reimbursement for anesthesia services has been shifting from a fee-for-service model to a value-based model that ties payment to quality metrics. The Centers for Medicare & Medicaid Service’s (CMS) value-based payment program includes a quality measure for perioperative temperature management (Measure #424, Perioperative Temperature Management). Compliance may impose new challenges in clinical practice, data collection, and reporting. We investigated the impact of an electronic decision-support tool on adherence to this emerging standard. METHODS: In this retrospective observational study, perioperative temperature data were collected from cases eligible for reporting this measure to CMS from a single academic medical center before and after the implementation of an electronic decision-support tool that prompted temperature measurement and maintenance of normothermia. Proportions of measure compliance were assessed using segmented regression analysis. Proportions of intraoperative temperature measurement were also assessed, and multivariable logistic regression was performed to assess the association between patient and surgical factors and measure compliance. RESULTS: A total of 24,755 cases eligible for reporting in 2017 were assessed, and 25,274 cases from 2016 were included as an extended baseline. Segmented time-series regression did not show a significant baseline trend in measure compliance. Introduction of the alerts was associated with an increase in overall compliance from 84.4% (95% confidence interval [CI], 83.6%–85.2%) to 92.4% (91.4%–93.4%), and an increase in intraoperative compliance from 26.8% (25.8%–27.8%) to 71.0% (69.6%–72.4%). The association between the alerts and overall compliance was also present on multivariable analysis. CONCLUSIONS: Implementation of an intraoperative decision-support tool was associated with statistically significant improvement in the maintenance of normothermia in cases eligible for reporting to CMS. This led to improved compliance with Measure #424 and suggests that electronic alerts can help practices improve their performance and payment bonus eligibility.

Implementation of continuous temperature monitoring during perioperative care: a feasibility study

“…The greatest improvements in adherence to monitoring guidelines were found during PACU care, where no patients received regular 15-minute monitoring in the usual care group versus 17/37 (46%) in the ZHF group. Yet improvements in pre- and intra-operative temperature monitoring are hypothesized to have the greatest impact on clinical outcomes by enabling pre-emptive action to prevent heat loss [ 11 ].…”

“…In contrast to other vital signs, there has been a lack of non-invasive continuous temperature monitoring devices with clinically acceptable accuracy [ 9 , 10 ] and intraoperative accessibility of data [ 11 ]. Various devices with different degrees of measurement accuracy are typically used with a single patient perioperatively.…”

“…Rigorous evaluation is needed to determine whether continuous monitoring with easy, visible access to temperature data results in improved process of care and patient outcomes [ 15 ]. Intraoperative decision-support tools and electronic alerts have been found to support improvements in perioperative clinical care and documentation, including perioperative hypothermia prevention [ 11 ]. Lakha and colleagues identified that intraoperative decision-support and electronic alerts improved perioperative hypothermia prevention, but specifically related to compliance with quality measures (Measure #424, Perioperative Temperature Management) when linked to payment bonuses for anesthesiologists [ 11 ].…”

“…Intraoperative decision-support tools and electronic alerts have been found to support improvements in perioperative clinical care and documentation, including perioperative hypothermia prevention [ 11 ]. Lakha and colleagues identified that intraoperative decision-support and electronic alerts improved perioperative hypothermia prevention, but specifically related to compliance with quality measures (Measure #424, Perioperative Temperature Management) when linked to payment bonuses for anesthesiologists [ 11 ]. In the absence of payment incentives, whether continuous capability and easily accessible temperature data translates to improved practices and patient outcomes is unclear [ 15 ].…”

A Century of Technology in Anesthesia & Analgesia

“…205 In May 2020, Anesthesia & Analgesia published a special issue on "Anesthesia and Artificial Intelligence," which covered most of these topics. 196,200,[204][205][206][207][208][209][210][211][212][213][214][215] Robotic and closed-loop anesthesia systems have also been featured in several articles. Notable examples include the Kepler intubation system, which enabled robot-assisted tracheal intubation, and the Magellan system, which performed robot-assisted ultrasound-guided nerve blocks.…”