Quality Committee Meeting Minutes 10.22.2018

Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE)

Quality Committee Meeting Notes – Monday, October 22, 2018

Agarwala, Aalok (MGH)

Lins, Steve (Bronson Battle Creek)

Angel, Alan (Bronson)

Aziz, Mike (OHSU)

Louzon, Kathryn (Beaumont Royal Oak/Troy)

Bailey, Meridith (MPOG)

Lucier, Michelle (Henry Ford)

Becker, Aimee (Univ of Wisconsin)

Mathis, Mike (MPOG)

Berris, Josh (Beaumont Farmington Hills)

Malenfant, Tiffany (Beaumont Trenton/Wayne)

Biggs, Dan (Oklahoma)

Mathis, Mike (Michigan)

Buehler, Katie (MPOG)

McKinney, Mary (Beaumont Dearborn/Taylor)

Chiao, Sunny (Virginia)

Nanamori, Masakatsu (Henry Ford Detroit)

Collins, Kathleen (St. Mary)

Pardo, Nichole (Beaumont Grosse Pointe)

Colquhoun, Douglas (MPOG)

Quinn, Cheryl (St. Joseph Oakland)

Coons, Denise (Bronson)

Poindexter, Amy (Holland)

Crawford, Joan (Mercy Muskegon)

Poterek, Carol (Beaumont)

Cywinski, Jacek (Cleveland Clinic)

Price, Matthew (Beaumont Royal Oak)

Domino, Karen (University of Washington)

Rensch, Robert (Bronson Kalamazoo)

Harwood, Timothy (Wake Forest)

Schmidt, Carol (Beaumont)

Hightower, William (Henry Ford W. Bloomfield)

Sharma, Anshuman (Washington University)

Heiter, Jerri (St. Joseph A2)

Schonberger, Rob (Yale)

Hitti, Nicole (Weill Cornell)

Shah, Nirav (MPOG)

Hightower, William (Henry Ford W. Bloomfield)

Studt, Lindsay (Beaumont)

Godbold, Michael (Tennssee)

Tollinche, Luis (Memorial Sloan Kettering)

Johnson, Ray (Beaumont)

Tyler, Pam (Beaumont Farmington Hills)

Kaye, Toni (AQI)

Valentine, J. Rachel (Cleveland Clinic)

Lacca, Tory (MPOG)

Vitale, Katherine (Beaumont D’Born / Taylor)

LaGorio, John (Mercy Muskegon)

Agenda & Notes

1. Minutes from September 24, 2018 meeting approved- posted on the website for review.

Recording available as well.

2. Roll Call: Will contact QI Champions and ACQRs directly to inquire about participation status

if missing. Other participants can review meeting minutes and contact Coordinating Center if

missing from attendance record.

3. MPOG Retreat – October 12, 2018

a. Slides and recording from retreat are posted on our website. Thank you all for attending.

4. Upcoming Events:

a. April 5, 2019 – MSQC/ASPIRE Collaborative Meeting

i. Schoolcraft VistaTech Center

b. July 26, 2019 – ASPIRE Collaborative Meeting

i. Lansing, MI

c. October 18, 2019 – MPOG Retreat

i. Orlando, Florida

5. Beaumont – Farmington Hills QI Story – Dr. Joshua Berris & Pam Tyler (ACQR)

a. Leveraging ASPIRE/EPIC data and questionnaires for practice improvement and reporting

b. Used Scan Tron “bubble sheets” to collect non-EMR data and reported findings through

Excel and VBA

c. Reported findings to administration, surgery and anesthesiologists through “ERAS

Dashboard” every month with personal data and departmental data.

d. Quality Improvement: LOS prior to implementation was 8.8 days for colorectal cases and

dropped to 4 days after implementation.

e. Discussion

i. (Nirav Shah) As we start to enable PACU data extraction our first sites will start to

submit enough data to start building outcomes measures. Initial ideas for metrics

to focus on are PACU pain and LOS.

6. Beaumont – Dearborn/Taylor QI Story – Dr. Katherine Vitale & Mary McKinney (ACQR)

a. Temp 02 and PUL 01 improvements using ASPIRE data

b. Created friendly competition between providers by exporting provider list and

anonymized their scores using excel.

c. Performance graphs was distributed to Anesthesia staff each month. An upward trend in

TEMP 02 performance was seen after graphs were presented.

d. PUL 01 improvements: Highlighted IBW incorporated into Epic making it more obvious to

providers.

e. Discussion:

i. (Nirav Shah) Were there any noted improvements in TEMP 03 through this

initiative as well?

1. ACQR continuing to review cases

f. (Mike Mathis) System level changes are great strategy in comparison to focusing

improvements with individual providers.

i. (Nirav Shah) Epic is going to make IBW display more prominently as part of their

foundation build. All sites will be able to include IBW in a more prominent

location after the next upgrade from Epic.

7. Measure Update - PONV

a. Add Reglan as anti-emetic?

b. How often was Reglan used?

i. 65,000 cases out of 2.5M general anesthetics last 2 years (2.6% of cases)

c. Formal vote from Quality Committee on measure changes moving forward. Will be able

to make modification to MIPS measures in 2019 with the removal of QCDR participation.

d. Use of Propofol as an anti-emetic is still pending.

8. Feedback Needed – TRAN 02

a. Success: Hematocrit value documented as less than or equal to 30% and/or hemoglobin

value documented as less than or equal 10 g/dL

b. No hematocrit or hemoglobin checked within 6 hours of anesthesia end

c. Feedback on Original Proposal from Forum:

i. Dr. Eric Davies: We need two separate measures. One to see how often and what

type of patients we get a post transfusion H/H and a second telling us what the

H/H is when it is measured. One needs to understand when and why we are

making a measurement to assign meaning to the result.

ii. Dr. Aaron Wood: Sample case [x] …To me this seems like good stewardship of

resources and would be very reasonable to include as a pass for tran-02.

iii. Dr. Zachary Price: reasonable clinical judgment should be rewarded and ordering

additional tests just to hit a metric seems wasteful

d. Assessment and Pan

i. Failures (Post-op Hct >30) map be occurring with appropriate care

ii. We may be encouraging inappropriate behavior (not checking post-op Hct) with

current measure specification

iii. We should exclude cases where Hct not measured post-op to prevent this

inappropriate behavior

iv. Need to discuss if changes are needed to TRAN 02 (will convene a smaller

meeting to follow) to make it more relevant.

Meeting concluded at 10:49am