Quality Committee Meeting Minutes 9.24.2018

Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE)

Quality Committee Meeting Notes – Monday, September 24, 2018

Attendees: P=Present; A=Absent; X=Expected Absence

Agarwala, Aalok (MGH)

LaGasse, Bob (Yale)

Applefield, Daniel (St. Joseph Oakland)

LaGorio, John (Mercy Muskegon)

Angel, Alan (Bronson Battle Creek)

Lins, Steve (Bronson Battle Creek)

Biggs, Dan (Oklahoma)

Louzon, Kathryn (Beaumont Royal Oak/Troy)

Bledsoe, Amber (Utah)

Lucier, Michelle (Henry Ford)

Buehler, Katie (Michigan Medicine)

Mathis, Mike

Chiao, Sunny (Virginia)

Malenfant, Tiffany (Beaumont Trenton/Wayne)

Coffman, Traci (St. Joseph Ann Arbor)

Mathis, Mike (Michigan)

Collins, Kathleen (St. Mary)

McKinney, Mary (Beaumont Dearborn/Taylor)

Colquhoun, Douglas (Michigan)

Moore, Jim (UCLA)

Coons, Denise (Bronson)

Nachamie, Anna (Weill Cornell)

Crawford, Joan (Mercy Muskegon)

Nanamori, Masakatsu (Henry Ford Detroit)

Cuff, Germaine (NYU Langone)

Obembe, Samson (Cornell)

Davies, Eric (St. Joseph Oakland)

Pardo, Nichole (Beaumont Grosse Pointe)

Douville, Nick (Michigan)

Poindexter, Amy (Holland)

Egnatoski, Deborah (Beaumont)

Poterek, Carol (Beaumont)

Hightower, William (Henry Ford W. Bloomfield)

Price, Zachary (Beaumont Grosse Pointe)

Heiter, Jerri (St. Joseph A2)

Rensch, Robert (Bronson Kalamazoo)

Hitti, Nicole (Weill Cornell)

Schonberger, Rob (Yale)

Horton, Brandy (A4)

Shah, Nirav (Michigan)

Jameson, Leslie (Colorado)

Shannon, Lori (Beaumont)

Johnson, Ray (Beaumont)

Sherman, Jodi (Yale)

Kennedy, Jori (Sparrow)

Tollinche, Luis (Memorial Sloan Kettering)

Kheterpal, Sachin (Michigan)

Vaughn, Shelley (Michigan)

Lacca, Tory (Michigan)

Wood, Aaron (Beaumont Farmington Hills)

Agenda & Notes

1. Minutes from August 27, 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. ACQR Retreat held at the Coordinating Center last Friday, September 21

4. MPOG Application Suite Upgrade

a. May experience some periods of downtime this week as sites perform this upgrade

b. Release notes will be posted to the website

5. Upcoming Events:

a. October 12 – MPOG Retreat/ASA Conference – San Francisco

i. Registration is open! https://mpog.org/events-news/mpogretreat2018/

ii. Featured Speakers

1. Dr. Robert Wachter (UCSF)

2. Dr. Thomas Insel (Mindstrong)

3. Dr. Elizabeth Whitlock (UCSF)

iii. QI Stories

1. Dr. Timur Dubovoy (University of Michigan)

6. CRNA/AA Champion: New role within ASPIRE

a. Help ensure that CRNA/AA QI leaders can attend meetings and help promote our clinical

objectives to the CRNA/AAs in collaboration with the physician Quality Champions

b. Practice leader and/or quality champion at each site can optionally designate CRNA /AA

champion and 1 backup

c. CRNA/AA champion has access to dashboard

d. CRNA/AA champion invited to monthly Webex and in person meetings

e. Let ASPIRE (mpog-quality@med.umich.edu) know if you have named a CRNA/AA

Champion at your site: Include name and contact information.

7. Beaumont- Grosse Pointe QI Story – Dr. Zachary Price & Nichole Pardo (ACQR)

a. Community hospital with 10 ORs

b. PUL 02: Changed default vent settings to 450cc, provided education to providers re:

ASPIRE measure. Improved by 39% in the last year.

c. PONV 01: monthly staff meetings and included this measure in the monthly newsl etter.

Staff Q&A session to address inclusion/exclusion criteria. 28% improvement over the past

8 months.

d. Monthly Newsletter: includes measure information for one ASPIRE measure each month

e. CRNAs and Anesthesiologists meet monthly to discuss ASPIRE measures and rationale

behind each measure to drive improvement.

f. OE Dashboard: Future plans to focus on multi-modal anesthesia using the new data

released in the opioid equivalency dashboard

8. Mercy Health Muskegon QI Story – Dr. John LaGorio & Joan Crawford (ACQR)

a. 21 ORs across 2 centers

b. New center being built in the next year & moving to Epic in 2020

c. Private practice joined national group (Mednax) in 2015: 38 new providers joined since

then (55 providers total)

d. 4 ACQRs since joining ASPIRE in 2015

e. This amount of change has presented challenges in onboarding new providers to ASPIRE

and the measures. As a result, several of the monthly case ‘failures’ were attributable to

new providers

f. Distributed ASPIRE pocket card, printed one-pagers, and monthly scorecard to all new

providers. Welcome letter sent to each new provider that specifically outlines the metrics

and their role in complying with each measure.

g. Showing improvement in compliance across the institution and specifically with new

providers for PUL 01 and TEMP 01 for the last 12 months.

9. New Measure Proposed: SUS 01

a. Draft spec presented by Drs. Lagasse and Sherman from Yale

b. SUS 01 measures the percentage of cases with mean fresh gas flow (FGF) equal to, or less

than 3L/min, during administration of halogenated hydrocarbons, and/or nitrous oxide.

c. Discussion

i. (Nirav Shah-MPOG): Will measure on a per case basis rather than on a per

provider basis as the dashboard infrastructure supports case level at this time

ii. (Drs. Lagasse and Sherman- Yale) Shorter cases: FGF will be higher which is why

the 30 minute exclusion has been recommended

iii. (Dr. Jameson- UnivColorado): Examine cases after measure is built to determine

additional exclusions for cases that require higher FGF

iv. (Drs. Jameson- UnivColorado): 3L/min is too high; 1L/min is the standard at

UColorado.

v. (Dr. Mathis- MPOG): Recommends examining the data after the measure is built

internally to determine the right threshold for FGF. Exclude the Cardiopulmonary

Bypass period since FGF will be turned off during this time. Instead of calculating

mean gas flow, use median or number of minutes above 3L/min rather than

median or mean.

vi. (Dr. Lagasse – Yale) – measure built in such a way to already exclude CPB as

measure requires that halogenated agent or nitrous > 0 for a portion of case to

be included.

vii. (Dr. Chiao- UVa): Compound A formation of Sevo- need to be cautious of limiting

FGF. Recommendation to build the first version of this measure and review data

for several months in order to determine what changes need to be made for the

second version of the measure.

viii. Dr. Moore- UCLA): Using median rather than mean is recommended. Step value

for the concentration should be used if available. Should we be considering the

gas used since the impact on the environment is different by each gas.

d. Next Steps: Publish the draft spec to the forum for further comments/feedback before

initial build of the measure.

10. Measure Updates

a. PONV 01- Tabled for next meeting.

b. TRAN 02- Tabled for next meeting.

Meeting concluded at 11:02am