Quality Committee Meeting Minutes 11.26.2018

Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE)

Quality Committee Meeting Notes – Monday, November 26, 2018

Abdullah, Arbi ‘Ben’ (Washington University)

Kheterpal, Sachin (MPOG)

Agarwala, Aalok (MGH)

Lacca, Tory (Michigan)

Applefield, Daniel (St. Joseph Oakland)

Ladd, Chris (MPOG)

Angel, Alan (Bronson Battle Creek)

Lagasse, Bob (Yale)

Aziz, Mike (Oregon)

LaGorio, John (Mercy Muskegon)

Bailey, Meridith (MPOG)

Lins, Steve (Bronson Battle Creek)

Berris, Josh (Beaumont Farmington Hills)

Louzon, Kathryn (Beaumont Royal Oak/Troy)

Biggs, Dan (Oklahoma)

Lucier, Michelle (Henry Ford)

Buehler, Katie (MPOG)

Malenfant, Tiffany (Beaumont Trenton/Wayne)

Clark, David (MPOG)

McKinney, Mary (Beaumont Dearborn/Taylor)

Collins, Kathleen (St. Mary)

Nachamie, Anna (Weill Cornell)

Coons, Denise (Bronson)

Nanamori, Masakatsu (Henry Ford Detroit)

Crawford, Joan (Mercy Muskegon)

Obembe, Samson (Cornell)

Cuff, Germaine (NYU Langone)

Pardo, Nichole (Beaumont Grosse Pointe)

Dardas, Kalle (Beaumont)

Poindexter, Amy (Holland)

Domino, Karen (University of Washington)

Poterek, Carol (Beaumont)

Egnatoski, Deborah (Beaumont)

Rensch, Robert (Beaumont Kalamazoo)

Goorin, Pattie (Sparrow)

Saager, Leif (MPOG)

Harwood, Tim (Wake Forest)

Schonberger, Rob (Yale)

Jason Haus (Beaumont Troy)

Shah, Nirav (MPOG)

Johnson, Ray (Beaumont Wayne)

Smith, Susan (Beaumont)

Heiter, Jerri (St. Joseph A2)

Studt, Lindsay (Beaumont)

Hitti, Nicole (Weill Cornell)

Tollinche, Luis (Memorial Sloan Kettering)

Horton, Brandy (A4)

Tyler, Pam (Beaumont Farmington Hills)

Johnson, Ray (Beaumont)

Vaughn, Shelley (Michigan)

Agenda & Notes

1. Minutes from October 22, 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. 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

d. Total of 6 Quality Committee meetings in 2019:

i. Monday, January 28, 2019 at 10:00 a.m. Eastern

ii. Monday, February 25, 2019 at 10:00 a.m. Eastern

iii. Monday, April 22, 2019 at 10:00 a.m. Eastern

iv. Monday, June 24, 2019 at 10:00 a.m. Eastern

v. Monday, September 23, 2019 at 10:00 a.m. Eastern

vi. Monday, November 25, 2019 at 10:00 a.m. Eastern

4. St. Joseph Mercy Hospital Oakland QI Story – Dr. Daniel Applefield & Cheryl Quinn (ACQR)

a. Using Trello to integrate MPOG’s initiatives with SJMH Anesthesia resident quality

improvement requirements

i. Started with p4p measures

ii. Adding MPOG toolkits for resident education and quality projects

iii. ASA difficult airway algorithm

b. Design Resident Quality Improvement Projects to encompass the Aspire measures.

i. Lead resident presents toolkits to other residents and reviews failed cases.

Residents submit in writing why the case failed and discuss ways to improve

practice.

ii. Creating an instructional curriculum for the Anesthesia Residents where they

police and educate themselves on monitoring the success of Quality Measures

defined by MPOG

c. Working on Transfer of Care in 2019 as well as PUL-02

i. Tidal volume chart currently on each anesthesia machine for quick reference

d. Arranged Trello dashboard in order of importance and frequently used information

e. Discussion:

i. All residents have signed in. Started initiative in October and will take time to see

impact.

ii. Security clearance from hospital needed to use Trello? – No. There is no patient

information on the Trello board however, everyone needs to get an official invite

to gain access.

iii. Moderators can only edit information on the Trello dashboard. Not all members

have access to move/add/delete information.

iv. Are residents using Trello via monthly feedback email or are they getting info

from other sources?

1. ACQR and QI champ review cases that have failed, point out major

offenders and educate individually.

2. Lead resident responsible for driving this project. Residents responsible

for looking up their own dashboard to identify failures as well as through

monthly feedback emails.

5. 2019 Plans

a. Work with selected sites to improve data quality for research and quality projects (data

cleaning!)

i. Cleaning to ensure all sites are contributing minimum data set.

b. Measure Plans:

i. Incidence of PONV in PACU

ii. Glycemic Management- expand GLU 01 and 02 to preop/PACU

iii. Respiratory Complications in PACU

iv. SUS 01

v. CARD 03

vi. PUL 03/PUL 04 – Pulmonary bundle (PEEP and low tidal volume measure)

c. Continue work with MSQC- focusing on respiratory and infection complications

6. Measure Update - PONV

a. Adding Reglan and Propofol infusion as acceptable anti-emetic for PONV-01

i. Based on formal vote from the Quality Committee

b. How often was Reglan used?

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

7. Feedback Needed – TRAN 02

a. TRAN-02 Summit Webex on December 5

@1500

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

value documented as less than or equal 10 g/dL

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

d. CARD-02

i. Added new Troponin concept for Cardiac Troponin I ng/L to the measure as sites

are starting to adopt this new unit of measurement for Troponin I – check your

mappings

ii. Working to see how High-sensitivity Troponin T plays into the measure

e. New MOCA Homepage

i. Located at https://mpog.org/quality/moca/

ii. Includes Enrollment button and current MOCA status view for those who have

already enrolled.

8. Reach out to the coordinating center with additional registry recommendations that MPOG

may have a blind eye to.

a. MPOG currently working on gathering SRTR data.

Meeting concluded at 10:46am