“Knowledge is Power” -- Sir Francis Bacon, 1597

AQI Reporting: Participant Webinar

Learning Objectives Update participants on AQI status Demonstrate new features of the AQI reports Discuss future directions and solicit opinions

The Challenge The government wants to know that Ma and Pa are getting the healthcare they deserve … and that our taxes pay for. 11/8/2018

We live in the Information Age… “Your data is going to be collected. Do you want it to be gathered by your friends or by your enemies?” * -- Keith Ruskin, MD * Goofy picture of Keith obtained in 5.4 seconds of internet search.

The AQI A non-profit 501(c)3 corporation Vision: To become the primary source for quality improvement in the clinical practice of anesthesiology Goal: To establish and maintain the National Anesthesia Clinical Outcomes Registry

AQI Registries NACOR AIRS PPAI 11/8/2018

NACOR: the National Anesthesia Clinical Outcomes Registry Electronic capture All cases (no bias) All available data De-identified, but with context Automated reporting Automated validation Analysis and reporting

NACOR to date 4,500,000 cases > 800 interested groups 160 participating practices Case data from: 100 groups 1100 facilities 8,500 providers 4,500,000 cases 11/8/2018

11/8/2018

Demographics 40,000 ORs in 5,000 hospitals in the US + Surgicenters, clinics, doctors offices, etc. 75 million procedures? 30-40m major anesthetics? 60% of surgery on an outpatient basis 60% of hospital $$ are surgery-related 3% annual growth in volume since 1990 11/8/2018

Providers 45,000 anesthesiologists 45,000 nurse anesthetists Median age 50 Working 50 hours/wk 25% female, but rising fast 45,000 nurse anesthetists 2,000 anesthesiologist assistants 11/8/2018

The “Average” Practice 36 anesthesiologists 20 nurse anesthetists Working in 9 facilities 92% are ASA members

11/8/2018

Top 20 Cases in NACOR Cataract Lap. appendectomy Lap. cholecystectomy Total knee arthroplasty PE Tubes Knee arthroscopy Upper endoscopy Lower endoscopy Tonsillectomy Cesarean section Lap. appendectomy Total hip arthropasty Adult inguinal hernia Hysteroscopy Carpal tunnel repair Oral surgery Shoulder arthroscopy Lumbar laminectomy Lithotripsy Hardware removal 11/8/2018

Top 5 “Non-Cases” in NACOR Labor analgesia Placement of arterial catheter Central line placement Brachial plexus injection Femoral nerve injection

Top 5 “Non-Cases” in NACOR Labor analgesia Placement of arterial catheter Central line placement Brachial plexus injection Femoral nerve injection

Patient Age

Age and ASA Physical Status 11/8/2018

Patient Age 11/8/2018

Gender Distribution 11/8/2018

11/8/2018

Surgical Procedures: Age and Gender 11/8/2018

Anesthesia Type 11/8/2018

Outcomes Measure Group Description (n=814,890 cases) Events Incident Rate Process Process outcomes 11,201 1.37% Major Serious adverse events; actual patient harm or significant risk 3,539 0.43% Minor Minor adverse event; without long-term impact 85,210 10.46% Admin Administrative outcomes; such as case cancel, extended PACU, unexpected admission 11,420 1.40% Mortality Patient death; excluding patients presenting for organ harvesting 293 0.04%

AQI REPORTS How To 22 May 2012

Login @ http://aqihq.org/ 11/8/2018

After Login 11/8/2018

AQI Practice Reports 11/8/2018

Reporting Categories Practice Patients Cases Outcomes Providers, Age, Gender, FTE, LOS, ASA Membership Patients Age, Gender, ASA PS, Location Cases Duration, Facilities, Provider, CPT Outcomes National, Practice, Provider, Facility, PONV 11/8/2018

Practice Reports 11/8/2018

Provider Distribution 11/8/2018

Patients – Age, Gender, ASA PS, Location 11/8/2018

Patient Gender by Age Patient - Gender 11/8/2018

Cases 11/8/2018

Cases - Providers 11/8/2018

Age and ASA PS 11/8/2018

Procedure Duration 11/8/2018

Filters Select Criteria for Filter Click View Report CPT Month ASA Class Facility Type Age Category Anesthesia Type Click View Report 11/8/2018

Outcomes 11/8/2018

Outcomes - National 11/8/2018

Minor Events 11/8/2018

Summary AQI has 4.5 M cases 1M+ with quality measures AQI is looking to help with your reporting needs: Hospital Administration MOCA OPPE / FPPE Joint Commission 11/8/2018

Have I forgotten anything?