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On October 31, 2016, the American Society of Anesthesiology Ad Hoc Committee on Data Definitions (Chair: Arnold Berry) finalized the AQI NACOR Data Element Conceptual Definitions for 2017. These definitions form the foundation for data collected by AQI NACOR , and data elements used in AQI-proposed CMS quality measures.

The attached spreadsheet is a work that has been in progress for several years by the SIG to identify related outcome terms within SNOMED CT, and to help align them where possible with certain AQI NACOR outcome terms.

  File Modified
Microsoft Excel Spreadsheet outcomes_snomed_20161120.xlsx 2016-Nov-20 by Patrick McCormick
Microsoft Excel Spreadsheet outcomes_snomed v5.xlsx Created by anorton on Tue May 26 19:01:37 Z 2015 last modified on Tue May 26 19:01:37 Z 2015 v1 v5 2015-Oct-14 by Collabnet Migration

Current AQI NACOR Outcome Data Elements Map

Question: should we create specific "perioperative outcome" terms in SNOMED CT which are children of findings terms?

OutcomeRelated SNOMED CT TermsAQI DefinitionNotes
Acidemia The accumulation of excess hydrogen ions or depletion of alkaline reserve (bicarbonate content) in the blood resulting in an arterial blood pH < 7.35  
Acute Kidney Injury (AKI) 

New kidney damage or a sudden decrease in kidney function. Criteria include:

  1. Increase in serum creatinine (Cr) > 0.3 mg/dl within 48 hours
  2. Increase in Cr to > 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days
 
Adverse drug reactionAny unexpected, unintended, undesired, or excessive response to a drug that requires discontinuing the drug (therapeutic or diagnostic), changing the drug therapy, or modifying the dose (except for minor dosage adjustments). The adverse reaction must be severe enough that it requires prolonged observation or stay in a health care facility, necessitates supportive treatment, negatively affects prognosis, or results in temporary or permanent harm, disability, or death. 
Airway Obstruction

An acute respiratory dysfunction that produces reduced airflow into the alveoli and an arterial oxygen saturation less than 90% and that results in bradycardia or other clinical signs of hypoxia; the obstruction can be anatomically localized (e.g., tumor, stricture, foreign body, laryngospasm) or generalized (e.g., bronchospasm, asthma)

 
Airway Trauma

An injury to any of the structures or tissues of the mouth, nasopharynx, oropharynx, or larynx resulting from the use of any airway device such as laryngoscope, oral or nasal airway, endotracheal tube, or stylet

Clarifying statement: The most common injury is to the teeth, but airway trauma includes other injuries such as mucosal tears or tongue lacerations. 

Dental injury is not included as a child of Airway trauma
Amniotic Fluid EmbolismAn obstetric emergency resulting from amniotic fluid, fetal cells, hair, or other debris that enters the maternal circulation via placental vessels and triggers an immune reaction.  
Anaphylaxis

A severe, life-threatening allergic response, which is rapid in onset and characterized by a sudden drop in blood pressure and/or respiratory insufficiency

Note: Elevated serum tryptase level may be used to confirm the diagnosis. Although anaphylaxis is a lifethreatening allergic reaction, there may be other manifestations such as urticaria, bronchospasm, and edema. Epinephrine is often required as part of the treatment.

 
Arrhythmia

New onset of an abnormality of the cardiac rhythm; a cardiac rhythm other than normal sinus rhythm, including atrial fibrillation, atrial flutter, ventricular tachycardia, ventricular fibrillation, 2nd or 3rd degree heart block

Synonym: irregular heartbeat

Clarifying statement: A disorder in which there is abnormal electrical activity in the heart.

410429000 |Cardiac arrest (disorder)| is a child of arrhythmia - does that make sense?

 

AspirationThe entry of material (e.g., food, liquid, gastric contents) into the respiratory tract and accompanied by consistent radiologic findings  
Awareness

A scenario in which a patient becomes conscious during a procedure performed under general anesthesia and subsequently has recall of these events

Synonym: Intraoperative awareness, awareness under anesthesia, recall of intraoperative events

Clarifying statement: Awareness should be limited to explicit memory and should not include the time before general anesthesia is fully induced or the time of emergence from general anesthesia or during an intraoperative "wake-up test", when arousal and return of consciousness are intended.

Should we create a synonym "Recall of intraoperative events"?

 

Bradycardia

Significant slowness of the heart rate that poses a threat to the patient and requires treatment.

Note: The heart rate that is considered bradycardic depends on the patient’s age and coexisting medical conditions.

 
Burn InjuryUnintentional damage to tissue caused by excessive heat; a lesion caused by fire, heat or any other cauterizing agent, including friction, caustic agents, electricity, radiation, or electromagnetic energy Create concept specific to operating room?
Cannot Ventilate

Inability to force oxygen into the trachea and alveoli for the purpose of oxygenating the blood in the pulmonary capillaries and removing carbon dioxide

Clarifying statement: Inability to generate an adequate tidal volume or produce active movement of oxygen into the trachea and alveoli despite multiple attempts despite instituting corrective actions such as changing head and neck positions, use of jaw thrust or airway devices such as oral or nasal airways or placement of a laryngeal mask airway or other supraglottic airway device. CANNOT VENTILATE may occur in patients with a tracheostomy when positive pressure does not produce active movement of oxygen into the trachea and alveoli.

SNOMED definition: "The clinical situation in which a conventionally trained anesthesiologist experiences difficulty with mask ventilation, difficulty with tracheal intubation or both."
Cardiac Arrest 

The unplanned cessation of the mechanical activity of the heart as confirmed by the absence of signs of effective circulation. Cardiac compression and/or defibrillation may be required for treatment.

Synonym: perioperative cardiac arrest, cardiopulmonary arrest, circulatory arrest

 
Case Cancelled Before Anesthesia Start Time

A scheduled procedure that is not performed on the scheduled procedure day and the decision not to perform the procedure takes place before Anesthesia Start Time.

Synonym: surgery cancellation; cancelled operative procedure

 
Case Cancelled Before Anesthesia Induction Time

A scheduled procedure that is not performed on the scheduled procedure day and the decision not to perform the procedure takes place after Anesthesia Start Time but before Anesthesia Induction Time. 

Synonym: Aborted surgery, surgery cancellation; cancelled operative procedure 

 
Case Cancelled After Anesthesia Induction Time

A scheduled procedure that is not performed on the scheduled procedure day and the decision not to perform the procedure takes place after Anesthesia Induction Time but before Procedure/Surgery Start Time.

Synonym: Aborted surgery, surgery cancellation; cancelled operative procedure

 
Case Delay 

The Surgery/Procedure Start Time occurs significantly later than expected in the context of institutional norms.

Note: Case delays may be due to patient issues (e.g., late arrival, insurance problems, abnormal lab values), system issues (e.g., test results unavailable, blood unavailable, equipment malfunction or unavailable, transport delay), or practitioner issues (e.g., no consent obtained, surgery, nursing or anesthesia personnel arrived late).

 
Central Line Associated Bloodstream Infection (CLABSI)

A primary bloodstream infection that develops in a patient with a central line in place within the 48-hour period prior to the infection onset. Criteria for diagnosis include any of the following:

  • Criteria 1: Patient has a recognized pathogen cultured from one or more blood cultures AND organism cultured from blood is NOT related to an infection at another site.
  • Criteria 2: Patient has at least one of the following signs or symptoms: fever (>38 degrees C), chills or hypotension AND signs and symptoms and positive laboratory results (two or more positive blood cultures drawn on separate occasions) are NOT related to an infection at another site
  • Criteria 3:  Patient < 1 year of age has at least one of the following signs or symptoms: fever (> 38 degrees C core), hypothermia (<36 degrees core), apnea, or bradycardia AND signs and symptoms and positive laboratory results (two or more positive blood cultures drawn on separate occasions) are NOT related to an infection at another site 
 
Central Line Placement InjuryA pneumothorax, hemothorax, or thoracic duct, cardiac, or vascular injury that results from an attempted or completed insertion of a central venous catheter.   

Should add new concept.

Harmonize these concepts and have new concept relate to one or both

 

Cerebrovascular AccidentThe sudden death of neurons in a localized area of brain due to inadequate blood flow that produces motor, sensory, or cognitive dysfunction (e.g., hemiplegia, hemiparesis, aphasia, sensory deficit, impaired memory) that persists for more than 24 hours.  
Coagulopathy

The impairment, inability or incapacity of the blood to form clots and is associated with clinical bleeding.

Clarifying statement: Coagulopathy is a disorder involving the elements of blood coagulation, including platelets, coagulation factors and inhibitors, and the fibrinolytic system and may be confirmed by abnormal tests of clotting (PT, INR, PTT) or decreased platelet count.

 
Coma

A state of profound unconsciousness, not present prior to the initiation of anesthetic care, in which the individual cannot be awakened, fails to respond normally to external stimuli, and does not initiate voluntary actions.   Exclude coma due to prolonged anesthetic effect or hypothermia (temp <34 degrees C).

Clarifying statement: Scenarios include profound unconsciousness following anoxic or ischemic events such as cardiac arrest; metabolic encephalopathy; thromboembolic event; or cerebral hemorrhage. 

 
Corneal Injury 

A corneal injury is either a corneal abrasion (a scratch or scrape on the cornea, the clear front window of the eye that transmits and focuses light into the eye) or exposure keratitis (inflammation of the cornea fromdrying of the corneal tear film).

Synonyms: Exposure keratitis, exposure keratopathy

Clarifying statement and criteria: Includes both exposure keratitis and corneal abrasion (diagnosed in any manner including with fluorescein examination of the cornea under ultraviolet light). Also includes any new symptom of eye pain treated with topical antibiotic (e.g., erythromycin) while in the post-anesthesia care unit/recovery area. Other causes of eye pain (e.g., acute angle-closure glaucoma) can be excluded by instilling one drop of local anesthetic (e.g., proparacaine) into the eye. If the pain is immediately and completely relieved, corneal injury is confirmed and acute angle-closure glaucoma is excluded.

 
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