Somnia Mobile Outcomes Form

This form is no longer utilized. Please go to:

https://outcomes.specialtybenchmarks.com

(Enter as six digits, e.g. "01-11-2011"

Type option 1Type option 2Type option 3Type option 4

ScheduledUnscheduledEmergency

Co-Morbid Conditions

Medical Procedure

OphthalmicCataractOculoplastic

CABG/ValveThoracicEP/Cath/TEE

C SectionUrg C-SectVaginal Delivery

MIPS Quality Measures

Pt. abstained from smokingPt. did NOT abstain from smoking but was counseled prior to day of surgeryNOT a current smokerNOT elective surgery -OR- NOT seen prior to day of surgery

Pt. rec'd anti-emetics of 2+ agents of diff. classes pre-op or intra-opPt. did NOT receive combination therapy - unspecified reasonPt. did NOT receive combination therapy - medical reasonPt. did NOT have 3+ risk factors (ADULT) -OR- did NOT have 2+ risk factors (PEDIATRIC) -or- NOT inhalational general anesthesia

Temp>35.5 C achieved within 30 min. before or 15 min. immediately after anesthesia end time.Temp>35.5 C NOT achieved within 30 min. before or 15 min. immediately after anesthesia end time.Temp>35.5 C NOT achieved - medical reasonDuration of Anesthesia < 60 min. -OR- anesthesia method is MAC

All elements usedNOT all elements used - unspecified reasonNOT all elements used - medical reasonN/A - CVC NOT performed

Beta Blocker administered within 24 hours of pre-opBeta Blocker NOT administered - unspecified reasonBeta Blocker NOT administered - medical reasonN/A - Isolated CABG NOT performed

Multimodal pain mgmt usedMultimodal pain mgmt NOT used- UNSPECIFIED reasonMultimodal pain mgmt NOT used MEDICAL reasonN/A- Emergent case or Pt < 18 years old

Perioperative Outcomes

:HourMinutesAM/PM Option