Facility Scorecard

Outcomes

Major Complications
Minor Complications
Complication Details

Quality

Handoff Protocol Used
Post Op Pain Control
Normothermia
Surgical Safety Checklist Used
Current Medications Documented

Productivity

Total Cases
By Case Revenue
Anesthesia Minutes
By Minutes Revenue

Efficiency

Surgeon Close to Cut Time (Flip Flop)
Surgeon Close to Cut Time
Wheels Out / Wheel In
Anesthesia Turn over Time
Anesthesia Ready

Utilization

Prime Time (7a-3p)
Cost of Underutilization
Morning Time (0a-7a)
Evening Time (3p-0a)

Throughput

Number of First Cases
Number of First Case Delays
Cost of First Case Delays
Same Day Cancellation by Anesthesia
Same Day Cancellation Reason
Number of Same Day Add Ons
Number of Patients Evaluated Prior Day

MACRA Compliance

ABG 7 – Post Op Pain Management
ABG 14 – Corneal Abrasion
ABG 28 – PreOp Eval for GERD
ABG 29 – PreOp Eval for Glaucoma
ABG 30 – PreOp Eval for PONV Risk
ABG 31 – PreOp Eval for Alcohol/Drugs

Descriptions

Outcomes

Major Complications (n)

Count of over 20 major complications, including:

• Death
• Cardiac arrest
• Perioperative myocardial infarction
• Anaphylaxis
• Malignant hyperthermia
• Transfusion reaction
• Stroke, cerebral vascular accident, or coma following anesthesia
• Visual loss
• Operation on incorrect site
• Operation on incorrect patient
• Medication error
• Unplanned ICU admission
• Intraoperative awareness
• Unrecognized difficult airway
• Reintubation
• Dental trauma
• Perioperative aspiration
• Vascular access complication, including vascular injury or pneumothorax
• Pneumothorax following attempted vascular access or regional anesthesia
• Major systemic local anesthetic toxicity
• Peripheral neurologic deficit following regional anesthesia

Minor Complications (n)

Count of minor complications, including:

• Dysrhythmia requiring intervention
• Myocardial ischemia
• Uncontrolled HTN
• Failed Regional Anesthetic
• Hypothermia (Temp <95.9 ̊F or <35.5 ̊C)
• Inadequate Reversal
• Unplanned hospital admission
• Wrong surgical procedure
• Equipment malfunction
• Fire in OR
• Airway fire in OR
• Corneal abrasion
• Fall in OR

Complication Details

List of each complication, provider names associated with case, and date of service.

Quality

Handoff Protocol Used

Percentage of patients, regardless of age, who undergo a procedure under anesthesia who have a documented use of a checklist or protocol for the transfer of care from the responsible anesthesia practitioner to the responsible care team or team member.

The key handoff elements that must be included in the transfer of care protocol or checklist include:

• Identification of patient, key family member(s) or patient surrogate
• Identification of responsible practitioner (primary service)
• Discussion of pertinent medical history
• Discussion of the surgical/procedure course (procedure, reason for surgery, procedure 
performed)
• Intraoperative anesthetic management and issue/concerns to include things such as airway, hemodynamic, narcotic, sedation level and paralytic management and 
intravenous fluids/blood products and urine output during the procedure
• Expectations/Plans for the early post-procedure period to include things such as the anticipated course (anticipatory guidance), complications, need for laboratory or ECG and medication administration.
• Opportunity for questions and acknowledgement of understanding of report from the receiving team .

Post Op Pain Control

Percentage of patients with pain score < 7 or "unknown" within 15 minutes of arrival.

Normothermia

Percentage of patients with a temperature of >35.5 degrees centigrade in the immediate postoperative period within 15 minutes of arrival in PACU.

Surgical Safety Checklist Used

Percentage of patients, regardless of age, who undergo a surgical procedure under anesthesia who have documentation that all applicable safety checks from the World Health Organization (WHO) Surgical Safety Checklist (or other surgical checklist that includes the applicable safety checks for the specific procedure) were performed before induction of anesthesia.

The WHO Surgical Safety Checklist includes the following items before Induction of Anesthesia:

• Has the patient confirmed his/her identity, site, procedure and consent?
• Is the site marked?
• Is the anesthesia machine and medication check complete?
• Is the pulse oximeter on the Patient And Functioning?
• Does the Patient have a:
• Known Allergy?
• Difficult Airway/Aspiration Risk?
• Risk of >500 ml Blood Loss (7ml/kg in children)?

Current Medications Documented

Percentage of patients who have had their home medications documented in the EHR.

Productivity

Total Cases (n)

Total anesthesia case count.

Revenue by Cases ($)

Total Cases * Estimated Revenue per Case

Total Anesthesia Minutes (min)

Count of total anesthesia minutes.

Revenue by Minutes ($)

Total Anesthesia Minutes * Estimated Revenue per Minute of Anesthesia.

Efficiency

Surgeon ToT – Flip Flop (min)

Surgery Start (Case 2) – Surgery End (Case 1), in which Case 1 and Case 2 have the same surgeon. This measures the Surgeon’s “Close to Cut” time when they have 2 different rooms and are “flip flopping” between them.

Surgeon ToT (min)

Surgery Start (Case 2) – Surgery End (Case 1), in which Case 1 and Case 2 have the same surgeon and same location. This measures the Surgeon’s “Close to Cut” time in the same room.

Wheels Out / Wheels In (min)

Anesthesia Start (Case 2) – PACU/ICU Arrival (Case 1), in which Case 1 and Case 2 have the same location and same surgeon.

Anesthesia ToT (min)

Anesthesia Start (Case 2) – Anes End (Case 1), in which Case 1 and Case 2 have the same Surgeon

Anesthesia Ready Time (min)

Anesthesia Ready (Case 1) – Anesthesia Start (Case 1)

Utilization

Prime Time Utilization (7a-3p)

Percentage of time the OR is being used across from 7:00a to 3:00p.

Revenue Opportunity Lost ($)

Amount of OR utilization minutes less than goal multiplied by estimated hospital revenue per operating room min.

Morning Time Utilization (0a-7a)

Percentage of time the OR is being used across from 00:00a to 7:00a.

Evening Time Utilization (3p-0a)

Percentage of time the OR is being used across from 3:00p to 00:00a

Throughput

First Cases (n)

Number of first cases.

First Case On Time Start (%)

Percentage of First Cases started on time.

First Case Delay Reasons

List of the delay reasons and number of occurrences, including:

• Patient Late
• NPO Violation
• Equipment Not Available
• Interpreter Not Available
• RN Not Available
• Anesthesia Not Available
• Surgeon Not Available
• Abnormal Lab Values
• Delay for Emergency
• Other

Cost of First Case Delays ($)

Number of delayed minutes multiplied by estimated hospital revenue per operating room min.

Same Day Cancellations (n)

Number of cases cancelled on same day as surgery by anesthesia.

Same Day Cancellation Reasons

List of the cancellation reasons and number of occurrences, including:

• No OR Time
• Equipment Failure
• ICU Bed Not Available
• Inpt Bed Not Available
• Abnormal Labs
• Patient Decision
• Patient No Show
• NPO Violation
• Change in Surgical Plan
• Other

Same Day Add On (n)

Number of cases added on the same day as surgery performed.

PreOp Prior to Day of Surgery

Number of cases evaluated prior to day of surgery.

MACRA Measures

ABG 7 – Post Op Pain Management

The percentage of patients 18 or older admitted to the PACU after an anesthetic with a maximum pain score 7/10 within 15 minutes of arrival.

ABG 14 – Corneal Abrasion

Percentage of patients having an anesthetic in the operating room/procedure room who experience any ocular surface injury requiring evaluation, follow up, or treatment prior to discharge from PACU.

ABG 28 – PreOp Eval for GERD

Percentage of patients that undergo an anesthetic in the operating room/procedure room who are questioned about symptoms of Gastroesophageal Reflux Disease during their pre-anesthetic evaluation.

ABG 29 – PreOp Eval for Glaucoma

Percentage of patients that undergo an anesthetic in the operating room/procedure room who are questioned about a history of Glaucoma or elevated eye pressures during their pre-anesthetic evaluation.

ABG 30 – PreOp Eval for PONV Risk

Percentage of patients that undergo an anesthetic in the operating room/procedure room who are questioned about Post- operative Nausea and Vomiting risk factors during their pre-anesthetic evaluation.

ABG 31 – PreOp Eval for Alcohol/Drugs

Percentage of patients that undergo an anesthetic in the operating room/procedure room who are questioned about alcohol and recreational drug use during their pre- anesthetic evaluation.