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.
Current AQI NACOR Outcome Data Elements Map
Question: should we create specific "perioperative outcome" terms in SNOMED CT which are children of findings terms?
|Outcome||Related SNOMED CT Terms||AQI Definition||Notes|
|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:
|Adverse drug reaction||Any 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.|
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)
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 Embolism||An 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.|
A severe, life-threatening allergic response, which is rapid in onset and characterized by a sudden drop in blood pressure and/or respiratory insufficiency
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
410429000 |Cardiac arrest (disorder)| is a child of arrhythmia - does that make sense?
|Aspiration||The entry of material (e.g., food, liquid, gastric contents) into the respiratory tract and accompanied by consistent radiologic findings|
A scenario in which a patient becomes conscious during a procedure performed under general anesthesia and subsequently has recall of these events
Should we create a synonym "Recall of intraoperative events"?
Significant slowness of the heart rate that poses a threat to the patient and requires treatment.
|Burn Injury||Unintentional 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?|
Inability to force oxygen into the trachea and alveoli for the purpose of oxygenating the blood in the pulmonary capillaries and removing carbon dioxide
|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.
|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.
|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.
The Surgery/Procedure Start Time occurs significantly later than expected in the context of institutional norms.
|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:
|Central Line Placement Injury||A 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 Accident||The 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.|
The impairment, inability or incapacity of the blood to form clots and is associated with clinical bleeding.
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.
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).