Morgan Brown, MD, PhD
Boston Children’s Hospital

Dr. Brown is a congenital cardiac anesthesiologist in the department of Anesthesiology, Critical Care, and Pain Medicine at Boston Children’s Hospital.  She is currently an associate professor and the Clinical Director for the Division of Cardiac Anesthesia.  She has trained in Canada and the United States, including obtaining her PhD in Clinical and Translational Science.  She has a long standing interest in quality improvement and safety, as well as risk assessment for patients with congenital heart disease.  She is the current Chair of the Society of Thoracic Surgeons-Congenital Cardiac Anesthesia Society Database (STS-CCAS) Committee, as well as the Past Chair of the Quality and Safety Committee of the CCAS.

What are you thinking about? 

I’m thinking about how to continuously improve both pediatric anesthesia and congenital cardiac anesthesia care.  There is little primary data from pediatrics and much of what we do is extrapolated from adult research.  In addition, many pediatric groups are very small with limited ability to see their own practice and what others are doing.  MPOG presents a rich resource for us to be able to examine contemporaneous pediatric anesthesia practice.

What are the practical implication for healthcare? 

We are now generating enormous amounts of data in anesthesia with every case that we do.  However, we’ve had limited ability to use this data to inform our practice.  I think MPOG allows us to start to do this.  I’m excited to try to get more pediatric centers onboard with MPOG – come join us!

How are you involved with MPOG? 

I am the Principle Investigator for MPOG at Boston Children’s Hospital.  In addition, I am the Vice-Chair of the Pediatric Quality Improvement Subcommittee and the Chair of a Pediatric Cardiac Anesthesia Working Group to try to refine our phenotypes and quality metrics for pediatric cardiac surgical cases.

Denise Schwerin, RN
Bronson Healthcare
Hello, my name is Denise Schwerin (shur ene) and I am the ACQR for Bronson Methodist Hospital and Bronson Battle Creek.  I have been a nurse for 21 years with the majority in the PACU at Bronson Battle Creek. I am also an abstractor for MARCQI. Getting Bronson up and running with ASPIRE was a new challenge for me, and one that I was excited to tackle.

I enjoy spending time in beautiful northern Michigan exploring, fishing, kayaking, snowmobiling and searching for Petoskey stones. I am married with three adult daughters, two granddaughters and a German Shepherd named Jedi.

Please describe your role 

As the ACQR for the Bronson system, I am privileged to work with some amazing providers and QI champions. I find my role unique in that I get to work with a couple of anesthesia groups. Each one brings a different perspective, and we are able to learn from each other as well as our collaborative partners. I maintain our data as well as share data with my champions, the quality department, and administration. I also work with our IT department to troubleshoot issues and to meet the requirements of new measures.

Why is quality interesting? 

I went into nursing because I wanted to make a difference. While a bedside nurse, I was able to make a difference to the patient in front of me. As part of ASPIRE and focusing on quality, I’m able to make a difference to countless patients. They will never know the name of the nurse who helped them in a quality role, but they really don’t remember their PACU nurse either!

How has your team used MPOG data to impact quality at Bronson? 

Data from MPOG has given us a way to measure our successes and opportunities. Bronson has used data to make multiple changes over the years. Changes include glucose data to update our periop order sets, PONV data to update our medication regimen, and SUS data to make changes to the inhalation agents used. There are numerous other changes Bronson has made over the years using MPOG data.

Brad M. Taicher, DO, MBA
Associate Professor of Anesthesiology, Pediatrics, and Global Health (Affiliate)
Assistant Director of Anesthesia Perioperative Services
Medical Director of Pediatric Perioperative Services and Children’s Special Procedures Units
Director of Anesthesia Patient Safety and Quality
Duke University School of Medicine

Brad Taicher DO MBA is currently an Associate Professor of Anesthesiology at Duke Health.  Originally from southeastern Massachusetts, he completed his undergraduate, medical school, business school, residency, and fellowship programs in Philadelphia, Pennsylvania prior to joining the Duke team.  His clinical practice centers around caring for pediatric patients, and his administrative roles focus on Clinical Operations and Perioperative Quality and Safety.  He is currently the Assistant  Director of Anesthesia Perioperative Operations for Duke Anesthesiology, and also serves as the Department of Anesthesiology Director of Quality and Safety.

What are you thinking about?

I am thinking about how we can leverage MPOG to accelerate the biomedical data lifecycle – retrospectively analyze practice, offer a framework for robust data collection in multicenter RCTs, leverage ASPIRE to accelerate translation of this research into clinical practice, develop appropriate metrics to support these endeavors, and finally prospectively validate the benefit and utility of such metrics across a large multicenter cohort. Having a unique database that supports both research and quality/process improvement allows us to accelerate this cycle and meaningfully impact clinical care in a timely manner, improving processes while reducing waste.

Why is this interesting to you?

We have long known that providing anesthesia care must extend beyond ‘passing gas’!  MPOG provides a vehicle to facilitate collaboration across major medical centers to demonstrate the value-add that our specialty can provide.  Reducing variation, ensuring equitable access to and delivery of care, understanding how and where anesthetic decision making may significantly impact surgical and hospital outcomes, etc.  What role do anesthesiologists play in surgical site infections?  Length of stay?  Catheter associated infections?  Quality of life?  Disease recurrence?

What are the practical implications for healthcare?

‘Fee for service’ is dying a slow death.  Value based care, vertically integrated health systems and co-management agreements are becoming a reality and are being seen more and more frequently.  We have an incredible opportunity to define how anesthesiology is capable of adding value to and reducing waste from our health systems.

How are you involved with MPOG?

I am currently chair of the MPOG Pediatric Subcommittee, am the ASPIRE Champion at Duke Health, and am collaborating with multiple institutions on PCRCs around both healthcare disparities as well as PONV.

Sharon Reale, MD
Brigham & Women’s Hospital

Sharon Reale is an obstetric anesthesiologist at Brigham and Women’s Hospital. Originally from Texas, she graduated from the University of Pennsylvania School of Medicine and completed anesthesiology residency at Johns Hopkins Hospital, followed by obstetric anesthesia fellowship at Brigham and Women’s Hospital. Sharon has an interest in trainee education and serves as fellowship program director and director of resident education for the obstetric anesthesia division. Sharon’s research focuses on leveraging large databases to study maternal morbidity and mortality, including rare comorbidities and outcomes.

What are you thinking about?

I am currently working on two obstetric anesthesia related MPOG studies, in various stages of development. The goal of the first study is to qualitatively describe the management of maternal cardiac arrest cases during admission for delivery. Maternal cardiac arrest is a rare event and the MPOG database, which is simultaneously large and also granular, is the perfect way to study these rare events. The second study seeks to assess the rates of adherence to several national obstetric anesthesia quality measures, and to see whether there are any factors that can help explain variations in adherence rates.

Why is this interesting to you?

Maternal cardiac arrest is a difficult event to study, given it’s (fortunate!) rarity. However, maternal complexity is growing rapidly and the management and etiologies of maternal cardiac arrest are varied. MPOG is truly one of the only databases large enough, with granular enough detail, to allow us to dive deeply into what happens during these cases. This will allow us to better understand how maternal cardiac arrests are managed nationwide, and also to better understand the etiologies behind them.

What are the practical implications for healthcare?

The obstetric anesthesia field as a whole is very focused on maternal morbidity and continually working to help decrease morbidity rates. The MPOG database, with its rich, diverse cases, can help us first understand frequencies of various causes maternal morbidity and mortality, and then, in turn, reasons behind them, which will certainly help advance our field.

How are you involved with MPOG?

I currently serve as the MPOG representative for Brigham and Women’s Hospital, helping to coordinate a variety of research projects at our institution among different anesthesia divisions. I am also a part of the MPOG Obstetric Anesthesia Quality Committee, which works to develop quality measures specific to obstetric anesthesia, in order to help us better assess our practices in order to improve them. I am also an MPOG Perioperative Clinical Research Committee (PCRC) moderator, helping to review MPOG proposals.

Wendy Owens, MSN, RN
MyMichigan Health

I earned my Bachelor of Science in Nursing and Master of Science in Nursing from Ferris State University. I have 28 years of clinical nursing experience in surgical services working Ambulatory Pre/ Post, OR, POHA and PACU. My experience provides a deep understanding of the barriers and facilitators in peri-op nursing.

Explain your role as an Anesthesiology Clinical Quality Reviewer (ACQR)?

My role as an Anesthesiology Clinical Quality Reviewer (ACQR) combines nursing experience with continuous measure performance review and data quality validation. This is achieved by monitoring data diagnostics, correct mapping of EPIC concepts to MPOG variables, monitoring monthly data from third party billers, flagged case review, and reinforcing education opportunities with MPOG quality improvement reports.  Disseminating evidence-based practice information and ongoing communication with anesthesia services at Alma, Alpena, Clare, Gladwin, Midland, and West Branch sites identifies barriers and provides feedback for improvement.

Why is quality interesting / important to you?

Quality is important to me because it supports a culture of safety and positive patient experience. Quality care, robust continuous process improvement and measurement aligns with positive outcomes and is achieved with evidence-based practices and collaboration. What I find interesting about quality care is often it is the current state processes that need improvement, not the provider caring for the patient.

How has your team used MPOG data resources to impact quality at your institution? 

A facilitator to MyMichigan Health success is the ability to compare anesthesia models at all sites and share strategies between providers. Process improvements include change in workflow, resolving a data capture issue, change in documentation, and adding medication to OR omni cells. Collaborative efforts with Dr. Garrett Fisher, Quality Champion, anesthesia leads, and managers using MPOG database improves overall system quality in temperature and glucose management, cardiac- thoracic surgery, smoking cessation, and sustainability measures.

Clark Fisher, MD, PhD
Yale University

Dr. Fisher is an anesthesiologist and research fellow at Yale School of Medicine. He grew up in Pittsburgh, Pennsylvania, and studied Molecular Biology and Neuroscience as an undergraduate at Princeton University. After a year as a clinical research coordinator at UCSF (University of California San Francisco), he joined the Tri-Institutional MD/PhD Program receiving his PhD in Winrich Freiwald’s Laboratory of Neural Systems at Rockefeller University, studying the neural basis of face perception. While finishing medical school at Weill Cornell Medical college, he discovered the challenge and joy of providing anesthesia. He went on to complete anesthesiology residency and adult cardiothoracic fellowship at Yale-New Haven Hospital. During training, he became excited about the opportunity that intraoperative records provide to understand anesthetic practice and its impact. As an MPOG outcomes research fellow, he has an ongoing MPOG projects examining opioid use during cardiac surgeries and how the quality of anesthesia care varies across the operating room day.

What are you thinking about?

In my MPOG projects so far, I’ve been interested in understanding how much variability there is in the care we provide our patients. Where I’d like to go next is to use this variation in care to understand how the decisions we make in the OR affect the health and wellbeing of our patients. I’m particularly interested in understanding the therapeutic windows of routine medications, and whether we can use smarter dosing to avoid adverse events that we currently chalk up to the limitations of our therapeutic standards.

Why is this interesting to you?

When I transitioned from basic science into anesthesia, I was gobsmacked by the wealth of data that we have. As a systems neuroscientist, I could work for years before I had enough data to draw a single conclusion. Once I did, I would then be left wondering whether what I was studying had any relevance to humans. As an anesthesiologist with access to MPOG, you start on day 1 with access to years of data with clear clinical relevance. The challenge becomes how to draw useful conclusions from the messy, real-life information.

What are the practical implications for healthcare?

MPOG gives us an unparalleled opportunity to understand the breadth of anesthesiology’s standard of care. Now that we can see how many different approaches are considered “standard”, we have a chance of learning which are superior. It’s our obligation as doctors to try to figure this out. Hopefully, by doing so, we can improve upon anesthesiology’s existing track record of safety even as our patients and their care gets more complicated.

How are you involved with MPOG?

Beyond being a grateful benefactor of MPOG’s research infrastructure, I’m on the MPOG Cardiac Subcommittee.  As an Outcomes Research Fellow, I’ve also had an opportunity to sit in on the Perioperative Clinical Research Committee and some of the other groups that keep MPOG’s quality and research missions humming.

Sunny Lou, MD, PhD
Washington University

I grew up in the Boston area suburbs and graduated from the Massachusetts Institute of Technology with an undergraduate degree in biology. I moved to Stanford University for a dual degree in medicine and systems biology, and then trained in adult cardiothoracic anesthesiology at Washington University in St Louis as part of an accelerated residency and fellowship research track. I stayed on as faculty, with appointments in the Divisions of Cardiothoracic Anesthesiology, Clinical and Translational Research, and the Institute for Informatics. My research is focused on the use of clinical informatics and data science to improve clinician workflow, efficiency, and the quality of clinical care.

What are you thinking about?

I’m thinking about ways in which we can leverage data from the electronic health record to develop clinical decision support tools that can improve patient outcomes and healthcare quality. For example, I’m interested in developing a tool that assesses a patient’s personalized surgical transfusion risk, which could be used to ensure that blood is prepared for patients who are likely to need it, while avoiding excessive preparation for patients who are likely not to.

Why is this interesting to you?

Much of the risk stratification we rely on to make decisions in our clinical practice are based on personal experience, which can vary by clinician. I think it’s important to make the communication of risk more quantitative and transparent, so we can make more data-driven decisions.

What are the practical implications for healthcare?

Individualized risk stratification enables us to provide the right care for the right patient at the right time, improving patient safety and reducing waste. For example, blood shortages have been a major problem recently. Improved surgical transfusion risk stratification

How are you involved with MPOG?

I’m currently one of the inaugural MPOG fellows. I’ve really appreciated the opportunity to gain experience conducting research using MPOG data. The didactic curriculum has also been very helpful to improving my understanding of the challenges and considerations for working with large, messy, multi-centered datasets.

Bradford Berndt, MD
Staff Anesthesiologist 
Bronson Methodist Hospital Kalamazoo

I am a native of southwest Michigan, and obtained a BA from Kalamazoo College, and an MD from Wayne State University. I headed to Duke University for my residency and fellowship in Adult Cardiothoracic Anesthesiology. Eager to return back to Michigan, I have been in private practice for nearly 7 years at Kalamazoo Anesthesiology, P.C., serving Bronson Methodist Hospital and other local sites since completing my training. I also serve as community faculty for the Western Michigan University School of Medicine. 

What are you thinking about?

I am pondering new ways to drive improved performance and clinical outcomes in my group’s practice. Everyone wants to provide the best medical care to their patients, and I am trying to help deliver this goal to my corner of Michigan. The treasure trove of data from MPOG is a fantastic resource that we are utilizing to help drive our providers toward continuous improvement.

Why is this interesting to you?

We owe it to our patients to provide the best care possible, and this shouldn’t be any different in a community setting or a large academic center. MPOG data is helping to further elucidate and validate metrics that truly seem matter for the practice of modern anesthesia care, and delivering this data locally is helping to improve patient care.

What are the practical implications for healthcare?

The data that I am able to share with our group has benefited us tremendously. The individually tailored provider feedback has helped pinpoint areas for celebration and for correction. Moreover, we have used the lessons learned from other MPOG sites challenges and successes to help drive local QI projects, most recently focusing on perioperative glycemic control and environmental stewardship. All of this will hopefully lead to continued improvement in anesthetic care for the patients we serve.

How are you involved with MPOG?

I have served as the Quality Champion for Bronson Methodist Hospital for nearly 3-years. Our group was an early member of MPOG, and I have enjoyed participating in the continued expansion of the collaborative.

Amit Bardia, MBBS
Assistant Professor
Massachusetts General Hospital

Dr. Bardia is an Assistant Professor of Anesthesiology and the Program Director for the Adult Cardiothoracic Anesthesiology fellowship at MGH. He is a cardiac anesthesiologist and cardiothoracic intensivist with a keen interest in peri-operative outcomes research aimed at improving healthcare delivery.

What are you thinking about?

I am thinking about the impact of various intraoperative practices on long term patient outcomes. MPOG database is ideally positioned to address these knowledge gaps.

Why is this interesting to you?

Anesthesiologists are rarely exposed to outcomes beyond the immediate perioperative period. Yet, our clinical management may have profound long-term impact on our patients. I fascinated to explore the long-term effects of our management on patient health and how to improve these outcomes.

What are the practical implications for healthcare?

Having a longitudinal picture of patient health in our minds, as opposed to a focus on limited perioperative episodes, anesthesiologists can substantially improve overall outcomes among surgical patients.

How are you involved with MPOG?

I have been involved in research projects utilizing MPOG data.  Preliminary data from one of these projects helped us secure an R01 Grant from AHRQ. I have also recently been appointed as one of the PCRC moderators.

Meredith Hall, MD
Staff Anesthesiologist
Bronson Battle Creek

I am currently a staff anesthesiologist for Anesthesia Associates of Battle Creek, a private practice serving Bronson Battle Creek Hospital. I was born in the small hospital in which I now work. I started my medical career attending PA school at Western Michigan University, and I worked as a surgical physician’s assistant here in Battle Creek for three years. I then moved to Ann Arbor for medical school at the University of Michigan. I stayed on and served as chief resident in the Michigan anesthesiology program where I achieved my goal of being able to return to my home town and work in the community.

What are you thinking about?

I am thinking about the importance of providing high-quality anesthesia in community hospitals like mine. Our group was fortunate to become affiliated with the ASPIRE program very early on. As a small anesthesia group, it can be difficult to evaluate the quality of the care we provide, especially in comparison to larger tertiary care centers. ASPIRE has provided us with the capability to objectively evaluate our group performance on a much larger scale.

Why is this interesting to you?

Coming from a large training program like the University of Michigan, I graduated very aware of the inherent differences between large institutions and smaller facilities when it comes to the opportunity to provide quality care. Smaller personnel numbers, fewer hospital-wide resources, and differences in equipment caliber are all potential disadvantages for us. I was delighted via my work with ASPIRE to see that real and clinically relevant changes can be made despite some of these potential disadvantages.

What are the practical implications for healthcare?

In fact, smaller groups like Anesthesia Associates of Battle Creek have the ability to excel in many of the quality measures. We have the unique ability to disseminate new information quickly within the group and we are nimble enough to make major protocol changes in short amounts of time. Providers can be addressed personally, allowing for swift performance interventions. Discussing ASPIRE quality measures as a team has become part of the group culture. The result is strengthening the group as a whole and providing better anesthesia care to our community, now with objective data to show that we are indeed doing just that.

How are you involved with MPOG?

I took over the role of Quality Champion at the beginning of 2022, inheriting the role from a senior partner who had been in the position since ASPIRE began. I have a unique advantage in this role, as I am a former Michigan anesthesia resident and know several of the ASPIRE and MPOG leaders on a personal as well as professional basis. I very much enjoy the collaboration between the bigger and smaller institutions, and I look forward to not only learning from others but sharing our quality protocols with them as well.

Lucy Everett, MD
Associate Professor of Anesthesiology
Massachusetts General Hospital

I practice pediatric anesthesiology and work in the pre-procedure assessment clinic at Massachusetts General Hospital; I am Associate Professor of Anesthesiology at Harvard Medical School.  I was a physician director on our health system’s Epic implementation, and currently chair Epic’s Adult Anesthesia Specialty Steering Board.  I have previously practiced at Seattle Children’s and VCU Health.  

What are you thinking about? 

I am thinking specifically about sustainability in terms of how our volatile anesthetics and nitrous oxide impact the environment.  Broadly, I’m thinking about how to give understandable, actionable information to providers to help to drive quality.  On the Epic side of things, I try to make sure that we align definitions with MPOG but also provide some complementary information.  As an example, we are working on summary reports to allow hospitals to identify areas with the highest gas usage.

Why is this interesting to you?

In general, providers want information about their performance and how to improve, but as the saying goes, the devil is in the details.  As MPOG participants know, it’s important to be sure that the data is accurate and relevant to our practice, and to explain specifically what the data is showing.  Sustainability is just getting broad traction in anesthesiology, so there’s a lot of room to get this information out to anesthesia teams, and a lot of interest both from providers and hospital leadership.  

What are the practical implications for healthcare?

Climate change has very real implications for our patients, and there is also overlap with health equity, as vulnerable populations may be impacted more by air quality or by climate disasters.  Broadly, availability of validated quality measures with national benchmarks provides a framework for targeted improvement.  The biggest challenge remains having bandwidth to make best use of all the data that is available!

How are you involved with MPOG?

I’m the technical champion for MPOG for all the Mass General Brigham sites, managing our mapping and any data issues – knowing the EHR build helps with this.  I join the quality and pediatric quality meetings, and PCRC, and am in the process of submitting a PCRC request to look at data from the pediatric PONV measure.  I work closely with our quality and research champions at MGH, and try to be a resource for anyone who wants to use the data in either of those areas. 

Jerri Heiter, RN
Anesthesiology Clinical Quality Reviewer (ACQR)
Trinity St. Joseph Ann Arbor, Chelsea, and Livingston

My name is Jerri Heiter, the first ACQR hired in Michigan back in 2014!  My career at Trinity Health began thirty-nine years ago, caring for all levels of acuity of patients on various units, predominately surgical.  In the decade prior to starting the ACQR role, I worked as a staff nurse/shift coordinator in the Pre- & Post-Op units at St. Joes Ann Arbor and Chelsea.

I enjoy the change of seasons, being active outdoors, travel, and time with friends & family.

My husband & I are proud parents of three incredible men and four grandchildren.  We especially enjoy the activities we share with our 2-year-old twin granddaughters.

Explain your role as an Anesthesiology Clinical Quality reviewer ACQR?

Representing the St. Joe’s Ann Arbor, Livingston, and Chelsea sites, my workflow includes upload and review of data across the ASPIRE continuum.  I work closely with Dr. Kileny and our CRNA Leads to track our performance, review cases, and brainstorm options for quality improvement.  We serve as champions and advocates for ASPIRE, ensuring that staff is up-to-date on latest information and addressing feedback or concerns, too.

Why is quality interesting / important to you?

Quality enables our team to advocate for holistic well-being and health. It’s rewarding to provide patient-focused care and reach the goal of excellent patient outcomes. The ASPIRE platform provides essential education, the validation of best practices, and the delivery of safe patient care.  This keeps me inspired and hopeful for the future of healthcare.    

How has your team used the MPOG/ASPIRE data and resources to impact quality at Trinity St. Joseph?

Our QI projects have gained momentum over the years as the ASPIRE model has grown.  Performance scores motivate us to closely examine our practice models by utilizing filtered reports to parse data and navigate trends.  For example, in Glucose management, we have deployed additional education on modification to our protocols to all perioperative providers to align with ASPIRE.  We’ve driven improvement by initiating warming before procedure, providing measure-specific placards on anesthesia carts, and implementing documentation changes to reflect the quality care that’s provided.  And with the recent changes that have impacted all of us… we have a lot to be proud of!

T. Wesley Templeton, MD, FASA
Associate Professor of Anesthesiology
Director of Faculty Development
Department of Anesthesiology
Atrium Health Wake Forest Baptist

I am an Associate Professor of Anesthesia at Wake Forest University in Winston-Salem, NC. Although I specialize in pediatric anesthesia, I also maintain an active adult practice. I maintain an active interest in both retrospective and prospective clinical anesthesia research and regularly collaborate with other clinicians around the country and around the globe. I am a recognized national and international expert in the field of one lung ventilation and difficult airway management in young children having published numerous peer reviewed articles and reviews.

What are you thinking about? 

Currently, I continue to think about endobronchial intubation versus use of bronchial blockers in small children for one-lung ventilation. Given the findings of our recently published MPOG study that mainstem intubation was associated with more hypoxemia than use of a bronchial blocker for one-lung ventilation, I’m wondering if airway trauma, bleeding, and partial or complete occlusion of the endotracheal tube in these cases is happening more often than we think, leading to significant intraprocedural events. One of the other issues I’m thinking about these days is residual neuromuscular blockade in children. According to recent reports as many as 30% of children have a TOF ratio <0.9 in the PACU, yet we see a very low rates of significant pulmonary complications in the vast majority of children. In most cases it maybe significantly < 1%. Clearly there is a disconnect here, or maybe we need to reexamine what the definition of residual neuromuscular blockade is clinically relevant in children.

Why is this interesting to you?

I think the findings in our recently published MPOG paper are important to all of us who take care of young patients undergoing thoracic surgery and one-lung ventilation. Even if this only happens at a rate of 2-4%, this is still significant and may represent a significant safety issue. With regards to residual neuromuscular blockade in children, we still don’t have a great handle on risk factors for residual neuromuscular blockade. Further, there is very little published literature here in terms of the incidence of clinically significant residual neuromuscular blockade. So, in a way, we’re kind of feeling around in the dark holding on to the adult community’s TOF monitor and their definitions of residual neuromuscular blockade. Maybe kids aren’t just little adults?

What are the practical implications for healthcare?

With respect to the first issue looking at increased rates of hypoxemia being associated with mainstem intubation, I think we can potentially improve outcomes and reduce the risk of endotracheal tube occlusion leading to the need for extubation and reintubation in situations of  extremis by using bronchial blockers in these young patients. Mainstem intubation clearly remains the method of choice for lung isolation during thoracic surgery in young children so there may be an opportunity here. Further, residual neuromuscular blockade is occurring in children, how much residual is too much residual (i.e. it leads to pulmonary or other complications) remains an open question in children and an opportunity to potentially improve outcomes.

How are you involved with MPOG?

I am on the MPOG pediatric subcommittee and have had two approved PCRC proposals. A manuscript from one of these proposals was recently published in Anesthesiology. We are beginning to clean and analyze the data for our second project looking at hypoxemia and one-lung ventilation in school age children. I am also involved with a group of MPOG investigators looking at PONV guidelines and their impact on the rates of PONV in children in our PACUs following procedures associated with an increased risk of PONV in children.

Mary McKinney, RN
Anesthesiology Clinical Quality Reviewer (ACQR)
Beaumont Health Dearborn and Taylor

My name is Mary McKinney and I have been working with MPOG/ASPIRE since 2016. I started my career working in a physician office during nursing school. In 1993 I began my nursing career on a cardiac step down unit, at Beaumont Farmington Hills, until an OR RN internship was offered and I jumped at the opportunity! I worked in OR for 8 years doing all services except open heart. I then spent 18 months as the Nurse Educator for Surgical Services when a charge position for Pre-op and Recovery became available. I then worked in that area for 9 years gaining great experience in the perioperative arena preparing me to move into a supervisory role for the department where I remained until the Aspire position became available. Moving into Quality was a great decision for me as a “seasoned” nurse and I was able to utilize all the experience I gained while dedicating my career to Surgical Services. I have been married for 38 years and have 1 son and 3 grandsons. I also have a passion for animal rescue!

Explain your role as an ACQR 

I am currently an ACQR for the Beaumont Health System and I represent Dearborn and Taylor. I enjoy sharing information and best practices with the staff at those site. I am lucky to work for a health system that has multiple sites as it allows me to work closely with the entire team to share process improvement ideas and feedback.

Why Quality interesting / important to you?

During my time as Supervisor of Surgery I was the department representative for internal quality. We met monthly to discuss cases that didn’t meet goals for had fallout practices. I would review the charts and take back the information to the department to assist in the development of process/practice changes that are necessary. Sometimes it took some searching to find the issue and that is one of my favorite things! Similar to solving a mystery! I enjoy finding a better way to make things happen in the best way!

What are the practical implications for healthcare?

Reducing practice variation and improving performance on quality measures is one of the core purposes of MPOG.

How has your team used MPOG?

Beaumont takes quality improvement very seriously. Our leadership has a focus on providing the best care possible and has adopted the mission to provide compassionate, extraordinary care every day. We can only accomplish this by providing care to our patients using the evidence based practice and setting and achieving goals that keep moving us forward.

Bishr Haydar, MD
Clinical Associate Professor
Department of Anesthesiology
University of Michigan 
Co-Chair, MPOG Pediatrics Committee

I’m a pediatric cardiac anesthesiologist at the University of Michigan and co-chair of the pediatric MPOG subcommittee. I am also director of congenital cardiac anesthesiology and associate program director of pediatric anesthesiology fellowship at our institution. Michigan (the state and the University of Michigan) have always been home, but I left for training at the Massachusetts General Hospital where I served as chief resident. I’ve been interested in medical education research with my former residency program director, in perioperative adverse event research in partnership with the Wake Up Safe pediatric patient safety organization, and have just forayed into administration as a pediatric cardiac anesthesiologist.

What are you thinking about? 

Improving clinical care, personally and for my group, is my main focus, and being supportive to my trainees and colleagues. My efforts focus on translating literature into actionable items, and to work to reduce variations in our care. The COVID-19 pandemic is taking up a fair amount of mental real estate as well. I try to be a source of clear, unambiguous and useful information for my friends and family.

Why is this interesting to you?

Our work as pediatric anesthesiologists is challenging, as many of our adverse events are under-reported and poorly captured by automated tools. The science that underpins our work isn’t as strong as those for adults, for many reasons. These include fewer cases, countless syndromes and co-morbidities that can be hard to systematically appraise, and the challenges inherent in studying a vulnerable population. I would propose that the “art” of anesthesia is therefore of greater importance in pediatric anesthesia than in the adult anesthesia, but we would nonetheless benefit from reduced variation.

What are the practical implications for healthcare?

Reducing practice variation and improving performance on quality measures is one of the core purposes of MPOG.

How are you involved with MPOG?

I have been the pediatric subcommittee chairman for about a year. I’ve been working closely with the MPOG team to refine our measures to make them more salient and relevant for member sites, but also to engage non-member sites who have been active in our subcommittee. We are fortunate to have many non-members participate actively in our meetings and we have been working closely with the Society for Pediatric Anesthesia’s Quality and Safety Committee to provide them with updates on our work, and to invite them to help share their insights and wisdom with our subcommittee. We are hoping for these connections to blossom into collaborations in the coming years.

Eric Sun, MD, PhD
Assistant Professor
Department of Anesthesiology, Perioperative and Pain Medicine
Department of Health Research and Policy (by courtesy)
Stanford University

I grew up in the Washington DC area and then headed out to New Jersey for college, where my plan was to enter a MD/PhD program and become a cancer researching/practicing oncologist…then I entered the MD/PhD program at the Pritzker School of Medicine at the University of Chicago and sort of changed my mind.  I ended up getting a PhD in business economics and entering the anesthesiology residency program at Stanford University.  I stayed on as faculty, and now spend most of my time doing research on opioids and health economics/policy.  

What are you thinking about?

Most of my current work is focused on persistent postoperative opioid use.  In particular, I’m interested in identifying either clinical decisions (i.e., regional anesthesia, ketamine infusions) or system-level policies (i.e., laws) that to reduce its risk.  As much as I can, I try to find ways to use quasi-experimental methods to reduce confounding and identify causal effects.

Why is this interesting to you?

The first reason why it’s interesting is because it’s an issue of practical importance to most anesthesiologists as well as our patients.  In addition, I enjoy the fact that my current work blends a lot of my training in medicine and economics.  

What are the practical implications for healthcare?

I imagine most anesthesiologists are interested in reducing the risks of persistent postoperative use, so understanding how we can do this either by the decisions we make in the OR or by influencing the healthcare systems we work in could help inform these efforts.

How are you involved with MPOG?

I’m mostly a consumer of MPOG’s data, but I also serve as the co-research PI for my institution.

Jessica Wren, BSN
Anesthesiology Clinical Quality Reviewer (ACQR)
Henry Ford Health System, Macomb and Wyandotte

Hello, my name is Jessica Wren and I have been working as an ACQR at Henry Ford Health System (HFHS) for a year and a half. I started my nursing career almost 6 years ago as a circulating nurse in the operating room at Henry Ford Macomb. Prior to earning my nursing degree, I earned my surgical technologist degree and worked as a surgical tech in L&D.

I enjoy reading, walking, and spending time with family and friends in my spare time. I am currently working towards a duel MBA/MSN degree, which takes up quite a bit of my free time. I also enjoy traveling and I am looking forward to doing so soon.

Explain your role as an Anesthesiology Clinical Quality reviewer ACQR?

I have a true passion for not only data analysis and quality improvement, but also caring for patients in the operating room, which my position as an ACQR allows me to do both in a unique way. I spend my time validating cases, mapping variables, reviewing flagged cases, and troubleshooting data issues. I work closely with my QI champions and anesthesia providers to help reach our goals of quality improvement at each of my sites. We brainstorm ways to improve practices that will lead to better patient care and outcomes. We have made changes to the pre/post op handoff sheets, developed multiple changes to increase peds patients temperature before entering the OR, formed small group meeting with CRNAs to discuss challenging areas, and meet with pre and post op staff members to educate on changes we are making in these areas.

Why is quality interesting / important to you?

Throughout my career in healthcare, I have always looked at caring for patient as if they are my own friends and family. I want my friends and families care to be based on evidence-based practice by healthcare team members who consistently strive to improve patient care and outcomes. Working as an ACQR gives me the opportunity to be a part of this process. I am grateful to be able to play a role in having a positive impact on quality and safety for patients undergoing anesthesia at HFHS.

How has your team used the MPOG/ASPIRE data and resources to impact quality at Henry Ford?

Henry Ford Macomb and Wyandotte, along with Allegiance, completed the onboarding process in the fall of 2020. It was a challenging onboarding process, as there were multiple data issues and concerns that needed to be solved. I worked closely with team members at both the coordinating center and Henry Ford to resolve the issues and onboard the three new sites. Henry Ford Detroit and West Bloomfield had already been participating in ASPIRE for a couple years prior to the other sites coming on board.

It has been rewarding this past year working as a team with the anesthesia providers to improve the quality of care and patient outcomes at both Macomb and Wyandotte. The Henry Ford ACQR team, along with the physician champions, leadership, and supporting staff also work together to share areas of success and areas for improvement across all 5 sites. Working together has allowed Henry Ford to improve in areas of care such as PONV, sustainably, and temperature regulation. We are currently working on ways to better improve sustainability, glucose management, and transfusion management. We are looking forward to building and implementing a glucose BPA to help improve our care of patients with high or low blood sugars. We have made great strides working as a team and I look forward to the improvements we can make moving forward.

Jonathan P. Wanderer, MD, MPhil, FASA, FAMIA
Medical Director, Perioperative Informatics
Associate Director, Vanderbilt Anesthesiology & Perioperative Informatics Research Division
Associate Medical Director, Vanderbilt Perioperative Evaluation Center
Associate Professor, Department of Anesthesiology
Associate Professor, Department of Biomedical Informatics
Vanderbilt Medical Center

My name is Jon Wanderer and I have been working as an anesthesiologist at Vanderbilt University Medical Center for the past 9 years. I was born on Long Island, New York, and received a BA and BAS from the University of Pennsylvania before heading to Cambridge University for graduate school, where I received an MPhil in biology. I returned to the University of Pennsylvania where I received my MD, and traveled next to Boston where I did my anesthesia residency at Massachusetts General Hospital. I joined Vanderbilt immediately after residency, where I am now the Associate Fellowship Director for the Clinical Informatics Fellowship Program and co-course director for the Foundations of Clinical Informatics in the Masters of Applied Clinical Informatics Program. I lead Vanderbilt’s Physician Builder program and a Medical Director of Perioperative Informatics. 

What are you thinking about? 

Most of my non-clinical time is spent thinking about how we can better leverage perioperative data in improving our delivery of health care, and in developing and testing improvements that we can make in our electronic health care records. We have both deeply complicated clinical workflows and a complex electronic healthcare

 record system, and designing our systems to help us deliver safe and effective perioperative care is an ongoing priority.  Additionally, we have huge volumes of data that we bring together to answer interesting questions that can help inform how we provide care. 

Why is this interesting to you? 

I have been interested in how we can better use our electronic health car

e records since I was a medical student. Coming from a computer science background, I was struck by how we solve some health care data problems through brute force, i.e. having a medical student or intern manually collate information across multiple electronic screens to “pre-round” on patients. We can do so much better, but need to resource the design and maintenance of our system to take full advantage of them. 

What are the practical implications for healthcare?

From a practical standpoint, improvement facilitated by changes to our electronic health care records have let us standardize care and roll out important initiatives such as Enhanced Recovery After Surgery.  In addition, we have been able to invent new systems for care coordination that have streamlined processes and increased the amount of time our clinicians can spend with their patients by cutting out unnecessary phone calls, documentation elements, and reducing clicks. 

How are you involved with MPOG?

I have been involved with MPOG since the early days, and have had the opportunity to help develop MPOG extracts for Vanderbilt on two different occasions, representing the two different electronic health care record systems we have used. It has been wonderful to see how the MPOG community has grown and how the research data accumulated has let us address increasingly complex and important questions in health care.

Most of my non-clinical time is spent thinking about quality, especially as it relates to the improved quality of care our patients receive which is where the PSH and MPOG come together. We sit on a treasure trove of information in our electronic medical databases of which we are only scratching the surface of discovering all the ways we can improve the quality of the care we deliver. I feel tailoring optimal treatments (especially anesthetics) to patient needs is the future of improving the quality of care. This requires research combined with clinical informatics and real quality implementation.

Gary Loyd, MD
Anesthesiologist
Henry Ford Health System

I was born and raised in Kentucky achieving a BA from the University of Kentucky and an MD from the University of Louisville where I also did my residency. Most of my clinical and academic career was at the University of Louisville, except for 2 years as Chair for the Department of Anesthesiology at West Virginia University and 2 years as Vice Chair for Research at the University of Florida at Jacksonville. During that time I earned a Masters in Medical Management with a focus clinical informatics from Carnegie Mellon University. For the past 5 years, I have been the Director of the Perioperative Surgical Home (PSH) at Henry Ford Health System (HFHS).

What are you thinking about? 

Most of my non-clinical time is spent thinking about quality, especially as it relates to the improved quality of care our patients receive which is where the PSH and MPOG come together. We sit on a treasure trove of information in our electronic medical databases of which we are only scratching the surface of discovering all the ways we can improve the quality of the care we deliver. I feel tailoring optimal treatments (especially anesthetics) to patient needs is the future of improving the quality of care. This requires research combined with clinical informatics and real quality implementation.

Why is this interesting to you? 

I have been interested and involved in quality of care since the early 1990s. I have taken classes at different universities, at healthcare corporations (like Humana), and with online quality and patient safety certifications. I am a self-taught computer science nerd from the 1980s and love the opportunity to practice clinical informatics (which is really what the PSH is). The opportunity to improve population health in this quality related way will help more patients in a shorter amount of time than I could have ever achieved as just a practicing clinical anesthesiologist.

What are the practical implications for healthcare?

I have already witnessed the reduced number of perioperative complications and mortality with combining MPOG initiatives with the PSH. It has been truly rewarding and worth continuing the quality initiatives we have already implemented and taking them to the next level. With healthcare quickly moving from financial reimbursement for doing things to patients to a reimbursement for the outcomes, all of these quality efforts will generate further allies to help us achieve our goals.

How are you involved with MPOG?

My involvement with MPOG is from a Health System perspective. I recruit the physician champions, quality nurses, and other personnel to be the implements of change at each clinical site. I support their development and serve as a resource when they need me and fill in at meetings if they cannot attend. I coordinate regular HFHS team meetings where we share ideas, successes, failures since we are usually all have the same quality challenges across all of our clinical sites. These meetings augment the quarterly MPOG meetings and allow us to more quickly improve our performances.

Vikas O’Reilly-Shah MD, PhD
Pediatric Anesthesiologist
University of Washington

I was born and raised in New Jersey, and attended Michigan State University on the Alumni Distinguished Scholarship graduating with degrees in biochemistry and philosophy prior to enrollment in the Medical Scientist Training Program at Vanderbilt University. After medical school and doctoral work in structural biology, I trained in anesthesiology and pediatric anesthesiology at Stanford University. After a relatively brief stint in private practice, I joined the faculty at Emory University where I led departmental data governance efforts including the development of a perioperative data warehouse. I currently serve as Associate Professor of Anesthesiology and Pain Medicine at the University of Washington, leading the Center for Pain and Perioperative initiatives in Quality Safety and Outcomes (PPiQSO) and serving as the Associate Chief for Perioperative Informatics and Outcomes at Seattle Children’s Hospital, which is my clinical home as well.

What are you thinking about? 

I’m spending a lot of time thinking about Data-Information-Knowledge-Wisdom pyramid and specifically how we can use data to accelerate improvement in patient care. Data by themselves can only get you so far; wisdom is not just the process of analyzing and visualizing that data, but achieving consensus on what that data means and what we need to do next as providers on the basis of what has been found. Whether we are talking about improving adherence to noncontroversial standards of care in pediatric anesthesiology or mitigating disparities in care, I am looking forward to working with MPOG to continue to push forward the use of data to understand where gaps exists, while at the same time working locally to build the consensus needed for real change.

Why is this interesting to you? 

On the quality side, we have an opportunity to use data to (a) help drive down the widely-cited 17 year gap between the development of medical knowledge and the adoption of that knowledge into medical practice; (b) improve care for patients across the board; (c) give providers with actionable insight into their own practice patterns and a target to hit. One the research side, the exciting combination of high-quality MPOG data with new data sources such as infection control data and outcomes registries will yield new insights into how we can be better perioperative physicians.

What are the practical implications for healthcare?

Let’s face it: the COVID-19 pandemic changed everything. A system that was already under financial pressure is now strained to the breaking point. We are facing a multifaceted crisis in our ability to deliver safe, effective, and equitable healthcare. Data is not healthcare, but can help us to be more patient-centered, more timely and efficient, more consistent, and more evidence-based in ways that are agile and adaptable to changes in that evidence base.

How are you involved with MPOG?

I assumed the role of IT Champion when I became director of PPiQSO, and have prioritized collaboration internally and extramurally to assist with efforts including NSQIP and STS registry integration at the University of Washington; the piloting integration of new data elements (related to infection control) into MPOG; review and development of ASPIRE measures for pediatric anesthesiology; and serving on the PCRC for the review of research proposals.

Pam Tyler, RN, BSN
Anesthesiology Clinical Quality Reviewer (ACQR)
Beaumont Farmington Hills and Troy

My name is Pam Tyler and I have been working as a Beaumont ACQR for the past 5 years. I started my nursing career 27 years ago on a cardiac stepdown floor, working my way through the ICU and ended up in the preop and post op area at Beaumont Farmington Hills for 15 years. After attaining my BSN 5 years ago, I joined the Quality Department as an ACQR in addition to developing the role of Enhanced Recovery Coordinator for Farmington Hills which led to my current role as the ACQR for Beaumont’s Troy and Farmington Hills.

I have been married for 33 years and have two incredible sons, Joey and Matthew. In my spare time I enjoy spending time with family and friends.

Explain your role as an ACQR?

As an ACQR we perform tasks, that are directed by the maintenance schedule provided annually by MPOG, including validating cases, mapping new concepts, attesting to the accuracy of the data, reviewing failed cases and troubleshooting any IT issues.  Each Beaumont site has their own goals and quality improvement initiatives however, our ACQR team works together to share ideas and review methods to reach success.  We send out a failed case review each month to our physician champion and those individuals that are working in quality improvement locally.  Whether it is an in per person or virtual meeting we discuss our findings and make plans for future process improvements and educational opportunities.

Why is quality interesting / important to me?

Quality in healthcare improves patient safety, outcomes and keeps providers up to date on new practices.  Providing care to patients as if they were my family member has been my motto throughout my nursing career and I have found that, although challenging at times, the Anesthesia Providers share the same dedication to Quality Improvement. Having an interest in the educational aspect of introducing measures then seeing the providers apply evidenced based research to improve patient outcomes is very gratifying and although I no longer provide hands on patient care it is rewarding to visualize the positive outcomes by utilizing a team approach to realize our goals. 

How has your team used the MPOG/ASPIRE data and resources to impact quality at Beaumont?

MPOG has combined technology and research to develop evidence-based measures used as tools for improving patient care.  The Beaumont ACQR Team, I along with Mary McKinney, Tiffany Malenfant, Nicole Pardo and Kristyn Lewandowski, worked together with a group including quality leadership, physician champions, CRNA champions, and IT to transition to Import Manager which was a challenging job for 8 sites!

Some of the tools we have developed are a provider measure guide and a newsletter, every other month, which are shared with the quality teams and providers.  This guide includes each measure requirement for success and essential goals. In the newsletter we share current standings of focused measures and introduce new measures. This platform allows the ACQR to share plans for future improvement opportunities, as well as information on how providers can become involved in the development of measures and goals that the various sites would like to see utilized. Much of this information stems from the monthly case review, that is performed by the ACQR, who shares the findings with the Quality groups and assists with a deeper look into root causes and what is required to meet the metric. We have found simple documentation issues to minor process breakdowns need revising allowing goals to be met with small changes leading to big results! 

Lee-lynn Chen, MD, FASA
Vice Chair for Mission Bay
University of California San Francisco

Lee-lynn Chen, MD, FASA is a Vice Chair for Mission Bay in the Department of Anesthesia and Perioperative Care at the University of California San Francisco.  He completed his anesthesia residency and critical care fellowship at UCSF and stayed on as faculty.  Currently, his practice incorporates the entire perioperative spectrum including covering the pre-operative assessment clinic, OR anesthesia, the post-operative pain service and the critical care service.

What are you thinking about?

Since early on in my career, I have been thinking about quality improvement and the iterative process of self-improvement.  I started by utilizing simulation as a tool for educating participants in a safe environment.  More recently, I have worked with a multidisciplinary team to bring enhanced recovery after surgery (ERAS) pathways to UCSF.  I am passionate about helping our health care providers and health care system provide the best care possible to our patients.

What are the practical implications for healthcare?

With big data, we have the opportunity to examine how we practice.  Using this information, we can then improve quality performance at the system level.  However, we need to make the connections that are relevant to our practice and close the loop to show providers how to improve their individual practice.

How are you involved with MPOG?

UCSF joined MPOG in 2019.  I am the clinical MPOG champion at UCSF working with both our QI and research teams.  Currently, we are planning to complete a MPOG + NSQIP/STS data registry integration, and we are looking forward to collaborating with others.  I hope to be able to develop new metrics and outcome variables that can further improve our specialty.

Amy Poindexter, BSN, RN
Holland Hospital

I have a Bachelor’s degree in Nursing from Northern Michigan University and have worked in a number of areas in nursing throughout my career, including 4 years in the OR. I’ve been an employee at Holland Hospital for 13 years and have spent the last 9 years working in the Quality Department. I have been the ACQR for Holland since 2015, when we joined ASPIRE, and am also an abstractor for MSQC. I live in Holland with my husband of 31 years and my two adopted granddaughters (ages 2 and 3) who keep me very busy when I’m not working.

Explain your role as an Anesthesiology Clinical Quality reviewer (ACQR)?

My role as ACQR at Holland gives me the opportunity to continue to impact patient care without being a hands-on nurse. While I spend my time mapping variables, validating data and investigating failed cases, these processes help to identify opportunities for improvement in patient care. I work closely with our ASPIRE Quality Champion and Leadership Team and am empowered to promote exceptional care in the anesthesia department. Through our years with ASPIRE, we have streamlined practices and brought standardization to anesthesia delivery to ensure that each patient receives high quality anesthesia care. By regularly sharing ASPIRE data with the anesthesia team, our Surgical Services Product Line and Holland Hospital Leadership Committees, we have increased our provider engagement, enhanced work-flows and are performing at or above goal on most of the ASPIRE measures. Because I represent both ASPIRE and MSQC, I help to bridge anesthesia and surgery staff to collaborate and provide the best experience for our patients.

How has your team used the MPOG / ASPIRE data / resources to impact quality at Holland Hospital?

ASPIRE allows us, a small community hospital, to be compared to and learn from large teaching hospitals. We can share best practices from other hospitals and adapt them to meet the needs of our patients and staff. Prior to participating in ASPIRE, we had no reliable way to measure anesthesia quality. Now we use the ASPIRE measures to shine a light on areas where we need improvement and to assist other Collaborative hospitals in areas where we excel. The outcomes data is especially helpful in evaluating our anesthesia delivery and practices.

William Hightower, MD 
Henry Ford Health System West Bloomfield

William J Hightower is an anesthesiologist at Henry Ford Health System, primarily based at West Bloomfield Hospital. He has an undergraduate degree in Mechanical Engineering from Northwestern University, attended medical school at the University of Virginia, and completed residency at Stanford University. He has been the ASPIRE quality champion at his site since Henry Ford joined in Cohort 3. He lives in Bloomfield Hills, Michigan with his wife and three daughters.

What are you thinking about?

I am contemplating how to regain the continuous quality improvement momentum we had prior to the COVID-19 pandemic. After a long interruption in surgical cases, and with so much emphasis on PPE and new safety protocols, we are now re-familiarizing our staff with the ASPIRE quality measures. We are also coming together as a department again, discussing lessons learned, successes and areas for improvement both in terms of our pandemic response and our normal clinical operations.

Why is this interesting to you?

As we get back into “new normal” clinical operations, we have to relearn how to do some of our daily work. ASPIRE serves an an excellent framework for discussions about standards of care, evidence, data analysis and improvement projects. While also focusing on protecting staff and patients from COVID-19, this is the perfect time to concentrate on quality of care, process improvement and outcomes!

What are the practical implications for healthcare?

Most of our anesthesiology staff were redeployed throughout the hospital in late March and April. At West Bloomfield Hospital, our entire group of nurse anesthetists staffed a newly created ICU 24/7 to accommodate the influx of critically ill COVID-19 patients. Anesthesiologists formed intubation and procedure teams to respond to needs in the ER, ICU and floors. Attending surgeons staffed COVID testing tents and even operated UV light sterilization devices to facilitate room turnover on the floors. Now we return to the OR with a heightened awareness of hospital operations beyond our normal work environment and a new appreciation of our role in patient-centered and system-based quality improvement.

How are you involved with MPOG?

As the quality champion for West Bloomfield Hospital, I work closely with our QC at Henry Ford Hospital and our ACQR. We communicate regularly about case review and share quality improvement projects. We utilize enhancements to Epic (best practice advisories, electronic decision support), staff education and dashboard review to move the needle on our scores. I just completed revising our system-wide PONV guidelines to be consistent with the ASPIRE measure specifications. I have found it easier to concentrate on a few measures at a time rather than overwhelm our staff with too much data. Quality improvement is a marathon, not a sprint. The opportunity to serve as QC has allowed me to see our department from new perspectives and serve new roles in our health system.

Leslie Jameson, MD
Associate Professor
University of Colorado

During my career in academic neuroanesthesiology I have had the privilege of serving in leadership roles  within the medical schools, universities and departments of which I was a member. I have developed intraoperative neurophysiologic monitoring and  medical education programs including CME Editor for Anesthesiology, and multiple publications in the subspecialty.   Most importantly though is the care I have given to hundreds of thousands of patients first at the University of Wisconsin then for the last 20 years at University of Colorado.  Patient care recommendations have been and continue to be driven by small trials that yielded answers that seem right. With all the genetic, behavioral, and immense medical care variability inherent in human physiology, these randomized controlled trials cannot possibly reflect the consequences of our actions on large populations. Consequently, many years ago I arrived in Ann Arbor for the very first organizational meeting of what became MPOG to find out “what really happens.”  This mantra continues to guide my clinical decision and my academic career.

What are you thinking about?

My practice is focused primarily on intracranial neurosurgery and complex multilevel spine in patients at very high-risk for infection, delirium and poorly controlled pain. Current literature suggests that with some surgical procedures preoperative conditioning, medication selection and active postoperative management makes a big difference in a patient’s long-term outcome. Does the drug choice,  combinations of propofol, ketamine, dexmedetomidine, and/or lidocaine really matter?  Which selections and actions reliably make a real difference in the patient’s ultimate recovery?

Why is this interesting to you?

This is the classic puzzle that drew me into MPOG.  There are so many declarations about the effectiveness these drugs/actions individually or in combination do which seem to be based on inadequate evidence and certainly not on the information about what “really” happens.  Establishing exactly what works and for whom means we are free to pursue better solutions for some, modify complications for others, and suggest  nonsurgical solutions when appropriate. This is boutique medicine based on information.

What are the practical implications for healthcare?

Suffering, failure to recover, and expenditure of treasure are classic responses and it is no longer far-fetched to imagine focused perioperative anesthesia care could ameliorates these issues.  If we can determine what “really happens” and to whom, then we, the anesthesiology sub specialties, can offer better medical solutions, ones that currently exist and ones yet to be imagined.

How are you involved with MPOG?

Since I championed MPOG at the University of Colorado, the support and interest shown by the senior leadership throughout the School of Medicine resulted in the creation of a group of 15 to 20 individuals who are actively engaged in MPOG, Surgery, and Emergency Medicine outcomes research endeavors. With great enthusiasm I represent Colorado at the Perioperative Clinical Research Committee (PCRC) meeting.  (Yes! I still need to take my turn validating data from UCHealth.)

Lee Fleisher, MD
Robert D. Dripps Professor and Chair
University of Pennsylvania

Lee A. Fleisher, MD, is the Robert D. Dripps Professor and Chair of Anesthesiology and Critical Care and Professor of Medicine at the University of Pennsylvania Perelman School of Medicine.  He is Chair of the Perioperative Brain Health Initiative which focuses on implementing strategies to reduce perioperative delirium and delayed neurocognitive recovery.  His expertise in quality of care measurement has led to his appointment to the Board of Directors, and roles as co-chair of the Surgery Standing Committee.   He is the current Chair of the Ambulatory Surgery Center Technical Expert Panel of the Leapfrog Group and a member of the Medical Advisory Panel for the Technology Evaluation Center of the Blue Cross/Blue Shield Association.  In 2007, he was elected to membership of the National Academy of Medicine (formerly Institute of Medicine) of the National Academy of Sciences and served on Committees of the NAM.

What are you thinking about?

How do we get to value-based healthcare and define quality of care?   Can we reduce low or no value care and where do anesthesiologists fit within this paradigm.   How do we continue to fund innovation (research) for our specialty?

Why is this interesting to you?

How do we use both data and the social sciences to drive change?  Can we use payment models to drive physician behavior and result in higher quality care.

What are the practical implications for healthcare?

Healthcare costs keep rising without a clear improvement in quality.    Alternative payment models may be the only way to bend the curve as well as drive a reduction in low value care.   Surgical care is one of the areas which can be impacted although that must include not performing surgery when the risks outweigh any potential benefit.    Data is key to understanding this issue.

Why are you involved with MPOG?

I am the executive sponsor for MPOG at Penn and currently serving my second term on the Board.  I have also engaged around the quality metrics.   Finally, I was the driver of upgrading to disseminate the report cards to the Department.

Kathleen Collins, MS, CRNA
Anesthesiology Clinical Quality Reviewer (ACQR)
St. Mary Mercy Hospital, Livonia, Michigan

Kathleen has been a staff CRNA and clinical instructor at St. Mary Mercy Hospital for 20 years. She became the ASPIRE Anesthesia Clinical Quality Reviewer at SMMH in 2017.  Previous clinical experience includes 10 years at Oakwood Hospital in Dearborn, MI, as a CRNA member of a closed Heart Team and a clinical instructor. Prior to graduating from the Mercy College of Detroit Graduate Program of Nurse Anesthesiology (1989), Kathleen worked for 5 years in the ICU of a major trauma center, followed by two years in Hemodialysis and Plasmapheresis

What are you thinking about?

As a life-long learner passionate about providing safe, high quality, evidence-based care, I’m an ASPIRE advocate. My practice has evolved over the years, much of it informed by non-anesthesia specific research. ASPIRE and MPOG provide clinicians with anesthesia-specific research outcomes, and influence best practice standards. Beyond conducting research, MPOG and ASPIRE have become a repository of knowledge, a source of perioperative clinical research that can have great impact on our patients not only perioperatively, but throughout their clinical course.

Why is this interesting to you?

We treat patients perioperatively but rarely see the results of our interventions. As providers, we want to do what is best for the patients who entrust themselves to our care. SMMH is a smaller community hospital with a Level 2 trauma center, but the ASPIRE care metrics indicate that our care and outcome performance on all measures compare positively to larger institutions and University hospitals. We have been able to leverage ASPIRE recommendations into changed periop workflow and improved patient care.

What are the practical implications for healthcare?

The research and quality metrics provided by MPOG/ASPIRE, particularly outcomes research, provide either evidence-based validation of, or challenge to accepted practice, and will positively impact future care. Locally, we have used ASPIRE to educate and influence periop staff performance. Globally, the ability to consistently share best practices and measure individual and site performance increases provider engagement and, ideally, improves patient outcomes. Reducing morbidity and mortality, reducing the cost of complications also reflects positively on the value of the healthcare we provide.

Why are you involved with MPOG?

As a CRNA, I contribute data to MPOG and ASPIRE. As an Anesthesia Clinical Quality Reviewer, I am responsible for assuring the data from SMMH is valid, the variables we upload are properly mapped, and that my CRNA and anesthesiologist colleagues are kept up-to-date with ASPIRE developments, measures, and performance feedback. I have been able to share the science behind ASPIRE measures, evidence-based practice recommendations, and present research articles published utilizing MPOG data. I have used my ACQR position to modify and share the excellent ASPIRE Surgical Site Infection Toolkit with my department. I subsequently collaborated with our Joint Program Coordinator and OR educator to share the ASPIRE SSI Toolkit with all of Periop Services. My work as ASPIRE ACQR has given Anesthesia a seat the SSI Subcommittee table, enhancing our influence and providing insight beyond the immediate perioperative arena.

Bhiken Naik, MD
Associate Professor
University of Virginia

Dr. Naik is Associate Professor of Anesthesiology and Neurological Surgery, Associate Medical Director-Neuroscience Intensive Care Unit and Program Director for Anesthesia Critical Care. His primary clinical work involves neuroanesthesia and neurocritical care. He is the MPOG and ASPIRE champion at the University of Virginia.

What are you thinking about?

I am thinking how the field of health informatics has progressed over the last few years, with MPOG being at the forefront of that revolution in the perioperative space. However, as an intensivist I see the gap in our knowledge base that needs to be bridged to provide accurate predictive outcomes for our patients across the continuum of intra- and postoperative care.

Why is this interesting to you?

Providing patients and families with accurate, personalized, evidence-based information is the first step in de-mystifying the surgical experience and more importantly, the long term recovery process. As we manage an increasingly aging population with multiple co-morbidities, this will be germane to our healthcare management.

What are the practical implications for healthcare?

With limited financial resources available in the future, it behooves us to leverage data to provide ‘smart’ care to our patients.

How are you involved with MPOG?

I am the site PI for MPOG for the last four years. This role affords me the unique opportunity to interact with colleagues across the country who have a shared interest. This has been an invaluable experience.

John LaGorio, MD
Mercy Health, Muskegon, Michigan

Dr. LaGorio practices anesthesiology in Muskegon Michigan.  He attended medical school and completed anesthesiology residency at the University of Michigan.  He joined his current practice in 1998, where he served as group President for several years.  He received his MBA from Indiana University’s Kelley School of Business in 2017.  Dr. LaGorio has served as Medical Director of Quality and Safety for Mercy Health Muskegon since 2014, motivated by an adverse hospital event in a family member.  He is immediate Past-President of the Michigan Society of Anesthesiologists and currently represents Michigan as Director to the American Society of Anesthesiologists.

What are you thinking about?

Healthcare Value- these words have almost become cliché, but the function of quality and cost in healthcare is becoming an ever increasingly important aspect for all stakeholders.  In my role as medical director of quality for our hospital, I have gained perspective on the critical nature of monitoring and improving quality while also remaining cognizant to the access, appropriateness and cost of care.

Why is this interesting to you?

Patient safety is part of our DNA as anesthesia providers, and makes focusing on high quality care for the patient on our OR table relatively easy.  In a systems context and with population health in mind, creating increased value becomes much more complex.  This complexity piques my interest and often challenges my previous positions.  I believe anesthesiologists have a unique combination of skill sets, fund of knowledge, and relationships to navigate this, particularly in procedural healthcare and armed with meaningful large data sets like MPOG.

What are the practical implications for healthcare?

With an aging and growingly unhealthy population, and healthcare expenditures surpassing 20% of the GDP, it is critical that we all work on this.  It will continue to grow as conversation from individual providers to medical groups to hospital boardrooms to the halls of Congress.  From individual therapeutic decisions to large scale network decisions, clinicians will need to be prepared for these discussions with information and data that will make meaningful arguments for the strategies necessary to improve the health of our nation in a much more agile fashion than ever before.

How are you involved with MPOG?

Mercy Health Muskegon has been involved with the ASPIRE cohort of MPOG partners since ASPIRE’s inception.  I have served as MHM’s physician champion to ASPIRE since that time and we remain proud to be a regional community hospital participating in such important and meaningful work.  I hope our participation has provided MPOG members with data and perspective of community based anesthesia care.  I know participation has allowed us to gain insight on our practice, investigate opportunities for improvement, and increase value to our hospital and patient community.

Patrick McCormick, MD, MEng
Vice Chair for Informatics
Department of Anesthesiology and Critical Care
Memorial Sloan Kettering Cancer Center

Dr. McCormick is the Vice Chair for Informatics of the Department of Anesthesiology & Critical Care Medicine at Memorial Sloan Kettering Cancer Center and an Assistant Professor of Clinical Anesthesiology at Weill Cornell Medicine. He is responsible for reducing barriers to perioperative care through improved workflow, processes, and system integration. Dr. McCormick is the chair of the Anesthesia Quality Institute (AQI) Data Use Committee, and vice chair of the AQI Anesthesia Incident Reporting System Steering Committee.

What are you thinking about?

American healthcare collects a substantial amount of information about patient care but does a very poor job of making it readily available to physicians and nurses. The reasons include variable data quality, clumsy user interfaces, and the narrow window of time clinicians have available to consult electronic charts.

Why is this interesting to you?

Analysis and presentation of clinical data is important not just for diagnosis and treatment, but longitudinal assessments of quality of patient care. On an individual level, anesthesiologists want to know what happens to our patients in the days and weeks after anesthesia.

What are the practical implications for healthcare?

Objective measurements of quality of care are necessary to build a culture of continuous improvement. Anesthesiologists need to be able to demonstrate that we are providing high quality healthcare so we can maintain our role as perioperative physicians.

How are you involved with MPOG?

I am the MSKCC Site PI for MPOG and am pursuing a project looking at the relationship between intraoperative plateau pressure and complications. I am always trying to improve the quality of the data my site contributes to MPOG.

Rebecca Schroeder, MD
Associate Professor of Anesthesiology
Clinical Director of Perioperative DataMart
Duke University School of Medicine

Dr. Schroeder is Associate Professor of Anesthesiology at Duke University and Clinical Director of the Perioperative DataMart.  Her clinical work has primarily been at the Durham Veterans Health Services Center in the areas of cardiac, thoracic and vascular anesthesia.  Her primary interest related to informatics is in leveraging electronic capture of healthcare data to improve delivery of care at the bedside.  Serving as MPOG site PI is one way of advancing that goal.

What are you thinking about?

Our role as perioperative physicians has expanded tremendously, but our ability to incorporate the patient’s perspective into surgical planning hasn’t really evolved past the risk/benefit discussion, especially for vulnerable populations for whom health literacy, cultural or communication barriers, socioeconomic status or other difficult to measure factors that go unrecognized or unaddressed.  To do this better, we need so much more information about the patient and the possible consequences of the choices he/she faces.

Why is this interesting to you?

Shared decision-making goes beyond simply asking a patient’s preferences, but also includes understanding what ‘health’ or ‘recovery’ means to each patient.  We all want to do the right thing, and to me, this is really doing the right thing in a whole new way.

What are the practical implications for healthcare?

The practicality of big data/precision medicine approaches in the perioperative area may seem dim, but the potential is huge.  For example, pain management rooted in patient-specific factors (epigenetics, psychosocial profile, comorbidities, etc.) combined with more traditional evidence has the potential to reduce or even eliminate racial, cultural and gender bias in treatment choice.  This would clearly improve the quality of pain management and also carries the possibility of collateral benefits for both providers and patients.

How are you involved with MPOG?

I have long been interested in the possibilities of multicenter health-services research that leverage use of locally captured health data combined with administrative, genomic, and other registry datasets.  I currently serve as the site PI for MPOG, and am excited about its potential as a common data model supporting such research efforts.

Michael Aziz, MD
Interim Vice Chair for Clinical Affairs
Professor of Anesthesiology and Perioperative Medicine
Oregon Health and Sciences University 

Dr. Aziz is Professor and Interim Vice Chair for Clinical Affairs in the Department of Anesthesiology and Perioperative Medicine at Oregon Health and Science University.  His clinical interests focus on regional anesthesia and head and neck anesthesia.  His research interests focus on airway management and database outcomes research.  He has worked extensively to establish the role of video laryngoscopy in difficult airway management and continues to collaborate with other MPOG investigators on outcomes research.

What are you thinking about?

I’m thinking about the changing landscape of healthcare and our challenge to provide the right care to the right patient at the right place and at the right time.   How can doctors help inform these decisions?

Why is this interesting to you?

I’m thinking from the lens of a clinical administrator who is also enthusiastic about the exploration of large datasets.  Healthcare systems are expanding to provide more efficient delivery of care, but we have little understanding on how we should triage care across the systems.  Who should go where and how can we re-create quality and excellence from environment to another.

What are the practical implications for healthcare?

These decisions are being made at an administrative level by those with knowledge of healthcare systems but they are not informed by research.  Physicians, together with other partners in science uniquely have the opportunity to investigate healthcare outcomes and correlate those to the different systems we apply.   I see quite an opportunity for an emerging space here in health services research.

How are you involved with MPOG?

I have been the local site PI for MPOG for many years.  The relationship goes back to my training at the University of Michigan as well as early research collaborations using our datasets before MPOG was even organized.  I would not have been drawn to MPOG if not for the vision of Dr. Kevin Tremper and leadership and mentorship of Dr. Sachin Kheterpal.

Joshua Berris, DO
Chairman
Department of Anesthesiology
Beaumont Farmington Hills, Michigan

Dr. Berris’ clinical work is at Beaumont Farmington Hills (formerly Botsford Hospital) where he currently serves as chairman.  Prior to his work in anesthesia and medicine, Dr. Berris was involved in information technology for a Fortune 500 company.  His continued interest in information technology drives his engagement with MPOG.

What are you thinking about?

How the addition of electronic data-feeds, record keeping and analysis has been slow to make meaningfully transformative changes in medicine.  We used to write our vital signs and now the computer writes them for us.  We used to sign the post-op visit on paper and now we use an electronic signature.  We type instead of handwrite. How much has the transition to these electronic functions really helped us or advanced outcomes?  Has it made us better doctors?  Has the rapidity with which we can do electronic tasks actually caused us to gloss over important points that in the past we were forced to think about while we were writing them?

Why is this interesting to you?

One doesn’t need to look far to see other industries which have embraced technology not just to automate the exact process a human would otherwise do. An articulating robotic arm can laser braze a car roof in a manner not possible by a person.  That person is then free to concentrate on other areas that can’t be automated.  The best part is it’s done this way because overall it is better and cheaper.  Hospital budgets have been exploding with IT costs. Forrester Research predicted Hospitals would spend 10% more on IT in 2018 over 2017.  It is a significant portion of every hospital’s budget and I don’t think other industries would accept our Return On Investment.

What are the practical implications for healthcare?

I would say there is poor communication and poor alignment at most hospitals between the true needs of clinicians, the workflow of clinicians, the regulatory requirements of everyday processes, the goals of administrators and the work that IT departments prioritize.  But there are outside industries that see these gaps in alignment and then develop products and services to sell to hospitals to fill the gaps. These products are costly and need to be jerry-rigged into existing workflows.  At the end of the day, the provider loses autonomy while at the same time financial resources have been depleted.  In summary, the practical implication is that if providers, administrators and IT departments don’t work together to meaningfully leverage the true potential of their existing EMRs, they will lose out to the innovators outside their institutions who have aligned to produce functional products; this is a costly mistake.

How are you involved with MPOG?

Another member of my department and I saw the potential of MPOG to bring real practice insight and change to our hospital and gladly joined up.  Since that time I have been using both the reporting provided by MPOG along with reporting based on data MPOG gathers to provide near real-time feedback to our providers.  In addition, I chair a committee composed of all the physician champions and ACQRs in our hospital system in order to share best practices developed at each site.  It has been a pleasure to be part of the advancement of anesthesia practice in cooperation with MPOG.

Karen Domino, MD, MPH
Professor and Vice Chair for Clinical Research 
Department of Anesthesiology and Pain Medicine
University of Washington School of Medicine in Seattle

I have a long standing interest in clinical outcome research utilizing cohort, case control, and mixed methods research methodologies. For over the past 15 years, I’ve directed the Anesthesia (formerly ASA) Closed Claims Project and Registries, which investigates adverse outcomes of patients undergoing perioperative anesthetic care using analysis of closed files at malpractice insurance organizations and use of specialized patient registries. In recognition of my research contributions to our specialty, I’m giving the 10^th John W. Severinghaus Lecture in Translational Science at the ASA Annual Meeting in October.  I’m the MPOG and ASPIRE champion for University of Washington hospitals.

What are you thinking about?

I’m thinking about the importance of risk-predictive models to guide clinical decision-making. Although quantitative risk-stratification models have been in use for decades, they are seldom used in clinical decision-making by physicians and patients.

Why is this interesting to you?

Many patients and families are concerned with the quality of life after medical and surgical treatments. However, physicians often only discuss the percentage of successful response or probability of death or major morbidity after a treatment, instead of outcomes that matter to patients. For instance, geriatric patients may fear the loss of ability to drive or ability to live independently, more than death.

What are the practical implications for healthcare?

With the emphasis on patient empowerment and shared decision-making in healthcare, risk-stratification and prediction of outcomes relevant to patients/families is needed. Addition of patient-centered and patient-reported outcomes to “big” data would enhance the ability for physicians to provide individualized risk predictions and improve patient engagement in decision-making, according to their values and preferences. Making treatment decisions that result in outcomes important to patients would reduce costs and improve quality of healthcare.

How are you involved with MPOG?

I’m the MPOG and ASPIRE Champion for the University of Washington Hospitals: the University of Washington Medical Center (a university hospital) and Harborview Medical Center (the only level 1 trauma center in the 5 state northwest US region).  I’ve been a long-term believer in multi-center outcome and quality research to adequately reflect the diversity of patients and practices in medical care. I’m especially excited about the use of the MPOG infrastructure as the basis for prospective enhanced observational and pragmatic clinical trials to study patient-reported and longer-term outcomes.

Robert Schonberger, MD
Associate Professor
Yale School of Medicine

Dr. Schonberger’s clinical work is in the Section of Cardiac Anesthesia where he cares for patients undergoing cardiothoracic procedures at Yale-New Haven Hospital. In his NIH-funded research, he studies the role of anesthesiologists in improving longitudinal cardiovascular risk-factor recognition and treatment among surgical patients. Other interests include 1) novel methods of extra corporeal circulation, 2) clinical informatics, and 3) methods of reducing and treating microembolic events in several clinical scenarios including cardiopulmonary bypass, ECMO, and decompression sickness. Dr. Schonberger is also the site PI for Yale’s participation in the Multicenter Perioperative Outcomes Group (MPOG) consortium.

What are you thinking about?

I am thinking about what it means for anesthesiologists to be good doctors. While safe intraoperative and ICU care are what the anesthesiology community is known for, I believe we must also ask what other obligations and opportunities for helping our patients to live longer and more fulfilling lives are allowed to pass in front of us every day.

Why is this interesting to you?

It is clear to me that if anesthesiologists do not think about our work in terms of “how to be a good doctor,” we will miss out on the greatest public health opportunities of our daily practice – specifically, how to help our patients engage in improving their postoperative health trajectories (e.g. getting folks engaged in preventive medical care, identifying and addressing poorly controlled hypertension, encouraging smoking-cessation, improving lipid management, and identifying other threats to our long-term health).

What are the practical implications for healthcare?

The implications for healthcare are simply that we should try our best to deliver more of it in ways that matter.

How are you involved with MPOG?

As a site-PI on the PCRC, I get tremendous satisfaction watching the diversity of investigators – and the projects they create – within MPOG. It is gratifying to play my own small role in making those projects possible, and it would be nice to bring more national and international recognition to MPOG from beyond the anesthesiology community. I think one of the keys to that effort is to compete for extramural funding using the MPOG infrastructure, and I am glad to see several projects heading in that direction.

Kai Kuck, PhD
President, Society for Technology in Anesthesia (STA)
Professor of Anesthesiology
Adjunct Professor of Bioengineering
Harry C. Wong Presidental Endowed Chair in Anesthesiology
Director of Bioengineering
University of Utah

Throughout my work, I have been involved in the research and development of innovative medical technologies with a focus on anesthesia and critical care. My areas of focus include cardiorespiratory monitoring, intelligent decision support, and ventilation.

My experience covers the whole range from hands-on engineering for hardware, software, algorithm, and graphical user interface development all the way to managing projects, programs, and large teams of researchers. In my last position I oversaw the research of Dräger, the global market leader in anesthesia equipment and critical care ventilation, Since 2014, in my role as Director of Bioengineering at the University of Utah’s Department of Anesthesiology, I have the privilege of working closely with clinicians and learning about real-world needs and opportunities for technologies.

Because transforming healthcare increasingly involves innovations at the system and workflow level, this collaborative approach is essential to creating technologies that address real needs in the clinic.

What are you thinking about?

I am thinking about how to take perioperative and anesthesia related data, learn from it, and then translate the learnings into clinical tools that can be used to help improve anesthesia patient care. With my biomedical engineering background, it also fascinates me to think about combining data and devices – both in terms of devices (think: wearables, mobile devices) that capture data and in terms of devices that use data.

Why is this interesting to you?

Industries, such as retail, financial services, marketing, are way ahead of healthcare and anesthesiology when it comes to using data to improve what they deliver. Currently, health IT has only begun to scratch the surface of its potential to improve care delivery. As these other industries are showing us, there is so much more potential. MPOG is building the infrastructure for data collection, multi-site collaboration, enhancing electronic data with context, data-based research, and translation into clinically usable tools.

What are the practical implications for healthcare?

Practical implications include the fact that we could then provide clinically useful information and decision support to clinicians who put so much work into entering data into electronic health records (EHR). We will likely be able to personalize healthcare delivery in a much more accurate manner than today. And finally, we could relieve anesthesiologists from some of the more tedious tasks, which computers are much better at than humans (store massive amounts of data, and then recall, select, and filter the data to be more relevant to one specific patient).  As a result, patient outcome will be better and healthcare delivery more efficient than today.

How are you involved with MPOG?

As a site-PI on the PCRC, I get tremendous satisfaction watching the diversity of investigators – and the projects they create – within MPOG. It is gratifying to play my own small role in making those projects possible, and it would be nice to bring more national and international recognition to MPOG from beyond the anesthesiology community. I think one of the keys to that effort is to compete for extramural funding using the MPOG infrastructure, and I am glad to see several projects heading in that direction.