MEASURE DESCRIPTION:
Percentage of patients with a known or suspected difficult airway who undergo a planned general endotracheal anesthetic that have both a second provider present at the induction and placement of the endotracheal tube and have difficult airway equipment in the room prior to the induction.
NQS DOMAIN:
Patient Safety
MEASURE TYPE:
Process
HIGH PRIORITY STATUS:
Yes
HIGH PRIORITY TYPE:
Patient Safety
INVERSE MEASURE:
No
RISK ADJUSTED:
No
INSTRUCTIONS:
This measure is to be reported each time an adult patient with a known or suspected difficult airway undergoes a planned general anesthetic requiring placement of an endotracheal tube. At the time of induction and placement of the endotracheal tube a second dedicated provider will be present to serve as an assistant for management of a difficult airway. Additionally, difficult airway equipment will be present in the room prior to induction in the event that such equipment is necessary to assist with placement of the endotracheal tube. It is anticipated that qualified anesthesia providers and eligible clinicians who provide denominator-eligible services will submit this measure.
Measure Reporting via the Qualified Clinical Data Registry
Patient demographics and CPT codes are used to identify patients who are included in the measure denominator. G-codes and Registry Codes are used to capture the numerator.
DENOMINATOR:
Patients, aged 18 years and older with a known or suspected difficult airway who undergo a planned general anesthetic with an endotracheal tube (identified with ABG Measure Response Code 1019)
-
Denominator Criteria (Eligible Cases):
Has a non-emergency procedure in which the anesthesia plan calls for general anesthesia with endotracheal intubation (ABG Response Code 1019)
AND
Patient is identified as a known or suspected difficult airway in the pre-operative period (ABG Measure Response Code 1073)
AND
Patient encounter during the reporting period (CPT):
00100, 00102, 00103, 00104, 00120,00124, 00126, 00140, 00142, 00144, 00145, 00147, 00148, 00160, 00162, 00164, 00170, 00172, 00174, 00176, 00190, 00192, 00210, 00211, 00212, 00214, 00215, 00216, 00218, 00220, 00222, 00300, 00320,00322, 00326, 00350, 00352, 00400, 00402, 00404, 00406, 00410, 00450, 00454, 00470, 00472, 00474,00500, 00520, 00522, 00524, 00528, 00529, 00530, 00532, 00534, 00537, 00539, 00540, 00541, 00542,00546, 00548, 00550, 00560, 00600, 00604, 00620, 00625, 00626, 00630, 00632, 00635, 00640, 00670,00700, 00702, 00730, 00740, 00750, 00752, 00754, 00756, 00770, 00790, 00792, 00794, 00796,00797, 00800, 00802, 00810, 00820, 00830, 00832, 00834, 00836, 00840, 00842, 00844, 00846, 00848,00851, 00860, 00862, 00864, 00865, 00866, 00868, 00870, 00872, 00873, 00880, 00882, 00902, 00904,00906, 00908, 00910, 00912, 00914, 00916, 00918, 00920, 00921, 00922, 00924, 00926, 00928, 00930, 00932, 00934, 00936, 00938, 00940, 00942, 00944, 00948, 00950, 00952, 01112, 01120, 01130, 01140, 01150, 01160, 01170, 01173, 01180, 01190, 01200, 01202, 01210, 01212, 01214, 01215, 01220, 01230, 01232, 01234, 01250, 01260, 01270, 01272, 01274, 01320, 01340, 01360, 01380, 01382, 01390, 01392, 01400, 01402, 01404, 01420, 01430, 01432, 01440, 01442, 01444, 01462, 01464, 01470, 01472, 01474, 01480, 01482, 01484, 01486, 01490, 01500, 01502, 01520, 01522, 01610, 01620, 01622, 01630, 01634, 01636, 01638, 01650, 01652, 01654, 01656, 01670, 01680, 01682, 01710, 01712, 01714, 01716, 01730, 01732, 01740, 01742, 01744, 01756, 01758, 01760, 01770, 01772, 01780, 01782, 01810, 01820, 01829, 01830, 01832, 01840, 01842, 01844, 01850, 01852, 01860, 01924, 01925, 01926, 01930, 01931, 01932, 01933, 01935, 01936, 01951, 01952, 01961, 01962, 01963, 01965, 01966, 01992
-
Denominator Exclusions:
ASA Physical Status = E
OR
Age <18
NUMERATOR:
The measure will be applicable to patients who by history or physical examination are known to have or are suspected of having a difficult airway and for whom general anesthesia with an endotracheal tube is planned. The measure will be considered met when a dedicated second provider is physically present in the room and is available to assist with induction and placement of the endotracheal tube. Additionally, the measure will be considered met when difficult airway equipment is brought into the room prior to induction to assist with the placement of the endotracheal tube if needed.
Numerator Note: suspected difficult airway - a difficult airway is defined as the clinical situation in which a conventionally trained anesthesiologist experiences difficulty with face mask ventilation of the upper airway, difficulty with tracheal intubation, or both. The difficult airway represents a complex interaction between patient factors, the clinical setting, and the skills of the practitioner.
Numerator Note: dedicated second provider - capable healthcare provider whose only responsibility at the time of induction is to provide assistance for management of the difficult airway. A dedicated second provider may include operating room staff: physician, certified registered nurse anesthetist, registered nurse, resident or anesthesia technician.
Numerator Note: difficult airway equipment - the definition of “difficult airway equipment” for this measure includes any advanced airway devices such as video laryngoscopes, intubating LMA, fiberoptic bronchoscope, Bullard, etc. Stylets and/or bougies unless they have been modified to include a light source or some other mechanical addition to manipulate their placement are not considered “difficult airway equipment”.
- Numerator Options:
Performance Met: A dedicated second provider is present at induction and placement of the endotracheal tube (ABG Measure Response code 1074)
AND
Use of difficult airway equipment, planned is reported (ABG Observation 036)
OR
Performance Not Met: A dedicated second provider is NOT present at induction and placement of the endotracheal tube (ABG Measure Response code 1075)
OR
Unplanned use of difficult airway equipment (ABG Measure Response code 037)
RELEVANT FIELDS:
- ASA CPT Code
-
Date of Birth
- Difficult Airway
-
Planned use of difficult airway equipment
-
Unplanned use of difficult airway equipment
REPORTING CODES: