In an effort to create a health care system that results in better care, smarter spending, and healthier people, the Centers for Medicare & Medicaid Services (CMS) implemented the Ambulatory Surgical Center Quality Reporting (ASCQR) Program in 2012. The ASCQR Program is a pay-for-reporting, quality data program requiring ambulatory surgery centers report on specific quality metrics in return for a full annual update to their annual payment rate.1
Earlier this year, CMS announced new measures will be added to the ASCQR payment determinations in 2020. ASC-13: Normothermia Outcome is one of the new measures and will require data to be submitted directly to CMS via the www.QualityNet.org website. Data collection begins on Jan. 1, 2018. Reporting will be required in 2019 impacting payment determination for 2020.1
ASC-13: Normothermia Outcome
ASC-13: Normothermia Outcome assesses the percentage of patients having surgical procedures under general or neuraxial anesthesia of 60 minutes or more in duration who are normothermic within 15 minutes of arrival in the post-anesthesia care unit (PACU).1 Data reporting is required for all patients that meet the measure criteria, as defined below.
A reasonable goal for this measure is a normothermia rate in the 95%-100% range.2
Develop Your Warming Strategy
With data collection starting in a matter of months, how do you prepare for the ASC-13 measure? Consider the following as you develop a patient warming strategy.
Conduct a temperature review. Determine how many of your patients currently are normothermic upon arrival at PACU. How you choose to measure and monitor patient temperature is an important consideration. Obtaining an accurate and reliable core body temperature reading becomes vital when determining the success of your warming protocol. 3M can help you take this key first step with a temperature review.
Determine a process for accurately documenting patient temperatures. A simple temperature tracking form can encourage data recording habits consistent with the measure. CMS offers a form template on its website.
Actively prewarm patients. One of the greatest contributors to surgical hypothermia is the physiological effects of anesthesia itself, which disrupts the body’s ability to regulate temperature.3 Prewarming, or increasing the total heat content of the periphery before surgery, can help offset the significant drop in temperature brought on by anesthesia induction, essentially stopping hypothermia before it might otherwise begin.4 Multiple clinical guidelines now recommend the use of prewarming to maintain normothermia.5-9
Expand the use of intraoperative warming. Selecting a warming system that can cover your entire range of needs while effectively serving your most difficult-to-warm patients can help your facility successfully meet the ASC-13 normothermia outcomes measure. The 3M™ Bair Hugger™ normothermia system’s expansive portfolio of products is cost-effective and designed to optimize clinical performance and ease of use.
Look to effective, proven normothermia solutions. Unintended perioperative hypothermia is a frequent, yet preventable, complication of surgery. It can increase the rate of wound infection (SSI)10-12, extend recovery time13, extend length of stay10 and increase mortality rates.14 The Bair Hugger system is the most clinically researched and proven portfolio of warming solutions on the market today, offering a wide range of patient warming products to help maintain normothermia throughout the surgical journey.
As the leaders in forced-air warming, 3M can help you meet your ASC-13 warming goals. We will work with you to understand your warming needs, identify your clinical challenges and evaluate your practice requirements so we can recommend proven, cost-effective solutions.
Visit go.3m.com/ASC to learn how we can help your ASC prepare for the new normothermia quality measure and your overall quality improvement program for SSI prevention.
- CY 2017 OPPS/ASC. 81 FR 79562. CMS-1656-FC.
- ASC Quality Measures Implementation Guide. Version 3.1. ASC Quality Collaboration, ascquality.org.
- Sessler, DI. Current Concepts: Mild Perioperative Hypothermia. N Engl J Med, 336(24): 1730-1737; 1997.
- Sessler DI, Schroeder M, Merrifi eld B, Matsukawa T, Cheng C. Optimal Duration and Temperature of Prewarming. Anesthesiology. Mar 1995:82(3)674-681.
- Nelson G, Altman AD, et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations – Part I. Gynecologic Oncology. 2016;140:313-322.
- American Society of PeriAnesthesia Nurses. Clinical guideline for the prevention of unplanned perioperative hypothermia. J Perianesth Nurs. 2001;16:305-314.
- Guideline for prevention of unplanned patient hypothermia. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2017:567-590.
- Anderson DJ, Podgorny K, et al. Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update. Infection Control and Hospital Epidemiology. 2014;35(6).
- Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, Itani KMF, Dellinger EP, Ko CY, Duane TM. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg 2017;224:59-74.
- Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med. 1996;334(19):1209–1215.
- Scott EM, Buckland R. A systematic review of intraoperative warming to prevent postoperative complications. AORN J. 2006;83(5):1090–1104, 1107-1113.
- Melling AC, Ali B, Scott EM, Leaper DJ. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomized controlled trial. Lancet. 2001;358:876-880.
- Lenhardt R, Marker E, Goll V, et al. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology. 1997;87(6):1318–1323.
- Bush HL Jr, Hydo LJ, et al. Hypothermia during elective abdominal aortic aneurysm repair: the high price of avoidable morbidity. J Vasc Surg. 1995;21: 392–400; discussion 400–392.