Release Notes:
Measure Information Form
Version 2010A1
Measure Information Form
Measure Set: Blood Management(BM)
Set Measure ID: BM-07
Performance Measure Name: Preoperative Blood Type Screening
Description: Selected elective orthopedic, cardiac and hysterectomy surgical patients who had preoperative blood type screening (type and crossmatch or type and screen) completed prior to surgery start time.
Rationale: Hospitals need to ensure that sufficient compatible blood is available for each scheduled procedure. Since about 3% of specimens have a serologic finding that requires further investigation that may cause a delay in the availability of the blood, patient screening of ABO group and Rh type should be collected in sufficient time to complete all pretransfusion testing before surgery begins. According to the Joint Commission’s Pre-publication National Patient Safety Goal UP.01.01.01 for 2010, a preprocedure verification process should be conducted to identify items that must be available for the procedure and use a standardized list to verify their availability. Documentation of any required blood products for the procedure is required. Development of formal protocols to ensure that patients have blood testing completed prior to surgery start time for potential high-blood loss elective surgeries may optimize management of blood resources and maximize patient safety.
Type of Measure: Process
Improvement Noted As: Increase in the rate
Numerator Statement: Patients with preoperative type and crossmatch or type and screen completed prior to surgery start time
Included Populations: Not applicable
Excluded Populations: None
Data Elements:
Denominator Statement: Selected elective surgical patients
Included Populations:
- Discharges with an ICD-9-CM Principal or Other Procedure Codes of selected surgeries as defined in Appendix A, Tables 2.2, 5.01, 5.02, 5.08, 5.11, 5.22, 5.23, 9.1 or 9.9.
Excluded Populations:
- Patients less than 18 years of age
Data Elements:
Continuous Variable Statement:
Included Populations:
Excluded Populations:
Data Elements:
Risk Adjustment: No.
Data Collection Approach: Retrospective data collection sources for required data elements include administrative data and medical records.
Data Accuracy: Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency.
Measure Analysis Suggestions: These data may be used to evaluate specific patient groups at high risk for a blood transfusion that did not have pre-operative transfusion testing completed and/or documented prior to surgery start time. The data could be further analyzed based on physician or type of procedure. Patients who are not included in the numerator could be tracked to see if there were any adverse outcomes due to the lack of preoperative testing.
Sampling: Yes.
Data Reported As: Aggregate rate generated from count data reported as a proportion.
Selected References:
* Saxena S, Nelson JM, Osby M, Shah M, Kempf R, Shulman IA. Ensuring timely completion of type and screen testing and the verification of ABO/Rh status for elective surgical patients. Arch Pathol Lab Med. 2007;131:576-81.
- Friedberg RC, Jones BA, Walsh MK. Type and screen completion for scheduled surgical procedures. A College of American Pathologists Q-Probes study of 8941 type and screen tests in 108 institutions. Arch Pathol Lab Med. 2003;127:533-40.
- Roback JD, ed. Technical manual. 16th ed, Bethseda, MD: AABB, 2008.
- Salido JA, Martin LA, Gomez LA, et al. Preoperative hemoglobin levels and the need for transfusion after prosthetic hip and knee surgery; analysis of predictive factors. J Bone Joint Surg. 2002;84: 216-20.
- Rady MY, Ryan T, Starr NJ. Perioperative determinants of morbidity and mortality in elderly patients undergoing cardiac surgery. Crit Care Med. 1998;26: 225-235.
- Magovern JA, Sakert T, Magovern GJ et al. A model that predicts morbidity and mortality after coronary artery bypass graft surgery. J Am Coll Cardiol. 1996;28: 1147-1153.
- Campbell DA, Henderson WG, Englesbe, MJ, Hall BL, O’Reilly M, Bratzler D et al. Surgical site infection prevention: the importance of operative duration and blood transfusion-results of the first american college of surgeons –national surgical quality improvement program best practices initiative. J AM Coll Surg 2008;207:810-820.
- The Joint Commission 2010 National Patient Safety Goals, Oakbrook Terrace, IL [Available at http://www.jointcommission.org/NR/rdonlyres/868C9E07-037F-433D-8858-0D5FAA4322F2/0/RevisedChapter_HAP_NPSG_20090924.pdf (accessed January 27, 2010).]
Measure Algorithm:
Attach file