Interpretation of CT Pulmonary Angiography (CTPA) for Pulmonary Embolism

Percentage of final reports for patients aged 18 years and older undergoing CT pulmonary angiography (CTPA) with a finding of PE that specify the branching order level of the most proximal level of embolus (i.e. main, lobar, interlobar, segmental, subsegmental); AND right ventricle to left ventricle (RV/LV) ratio, when assessable. If the RV/LV ratio is ?1.0, report the specific ratio value, as this may be associated with increased risk for adverse outcomes, and if the RV/LV ratio is <1.0, report that the ratio is within normal limits, optionally including a range (e.g., 0.7-0.9) to support clinical context.

Standardized Spine Fracture Classification Using Validated Systems

Percentage of final reports for patients with acute spinal fractures undergoing initial CT of the spine that include descriptive imaging findings.

Postoperative Ambulation

Percentage of patients ages 18 years and older, undergoing elective total hip and knee arthroplasty, who ambulated postoperatively on the day of surgery.

Risk-Standardized Routine Discharge Rate Following Elective Primary Hip and Knee Arthroplasty

Risk-standardized rate for routine discharge for elective primary total hip and knee arthroplasty.

Cement Use for Displaced Femoral Neck Fracture in Older Adults

Percentage of patients ages 70 years and older, undergoing hip arthroplasty with a displaced femoral neck fracture, who received a cemented femoral stem

Sepsis diagnosis and management: Lactate Level Measurement, Antibiotics Ordered, and Fluid Septic shock outcomes: Lactate clearance rate of greater than equal to 10%

This measure will be calculated with 2 performance rates:
1. Percentage of patients aged ≥ 18 years visiting the emergency department with sepsis or septic shock resulting in hospital admission or transfers and who had an order for all the following: a serum lactate level, antibiotics, and >= 1 L of crystalloids.
2. Percentage of patients aged ≥ 18 years visiting the emergency department with septic shock resulting in hospital admission or transfers who had an initial and repeat lactate performed, where the first serum lactate result (>2mmol/L) is elevated and a lactate clearance rate of >= 10% achieved during the emergency department visit.

Hepatitis B Safety Screening

If a patient is newly initiating biologic OR new synthetic DMARD therapy (e.g. methotrexate, leflunomide, etc.), then the medical record should indicate appropriate screening for hepatitis B in the preceding 12 month period.

Chest Pain – Avoidance of admission for adult patients with low-risk chest pain.

Percentage of adult patients who came to the Emergency Department with low-risk chest pain and were discharged.

Syncope – Avoidance of admission for adult patients with low-risk syncope

Percentage of emergency department (ED) visits for patients aged 18-50 years with a diagnosis of low-risk syncope who were discharged

Avoidance of Chest X-ray in pediatric patients with Asthma, Bronchiolitis or Croup

Percentage of ED visits for pediatric patients with Asthma, Bronchiolitis or Croup for whom a Chest X-ray was ordered/performed.