Obstetric Anesthesia Subcommittee Minutes

October 20, 2020

1:00-2:00pm EST

Zoom

X

Sharon Abramovitz, Weill Cornell

Arvind Palanisamy, Washington University

Ami Attali, Henry Ford- Detroit

Carlo Pancaro, Michigan Medicine

Jenifer Henderson, St. Joseph Oakland

Ashraf Habib, Duke

X

Rachel Kacmar, University of Colorado

X

Tom Klumpner, Michigan Medicine

Joanna Kountanis, Michigan Medicine

X

Nirav Shah, ASPIRE Director

Washington

Francisco

X

Wandana Joshi, Dartmouth University

X

Brooke Szymanski, MPOG QI Coordinator

X

Angel Martino, Sparrow Health System

X

Antonio Gonzalez, Yale

iii. August 4, 2021 1-2pm EST

iv. November 3, 2021 1-2pm EST

Forum

dashboards to support the subcommittee efforts; supported fully by MPOG- no longer

supported by an outside vendor

web case viewer to identify patients with severe pre-eclampsia

iii. Let us know if there are any issues with false flagging cases with pre-eclampsia

or any cases that may have been missed with the diagnosis code

HELLP included)

iii. Include scheduled and conversion cases

iv. Include urgent and emergent cesarean deliveries

2. Neuraxial start Time

3. Cesarean Delivery start time

once it is released. This feedback is used to refine the phenotypes further for

improved accuracy.

Anesthesia Technique- neuraxial phenotype

days before day of surgery to 7 days after

vii. Placenta previa with hemorrhage, third trimester (ICD-10: O44.13)

viii. Hemorrhage from placenta previa, antepartum condition or complication (ICD-

10: 641.13)

ix. Hemorrhage from placenta previa, delivered, with or without mention of

antepartum condition (ICD-10: 641.11)

included in the exclusion criteria? Those should be excluded.

onset of labor, or only before onset of labor as listed?

vi. Nirav Shah (ASPIRE Director): We will need to look through the code and see if

there is a more applicable code

minutes of hypotension as well as the time from neuraxial placement to delivery

1. Kate Buehler (MPOG): Case list does show number of minutes of

iii. Brandon Togioka (OHSU): Also had issues with that in the past- moved to pre-

filled syringes of phenylephrine

iv. Rachel Kacmar (University of Colorado): Same at Colorado, we’ve move to using

pre-made syringes of 10mL of phenylephrine which is enough to treat initial

hypotension before getting a drip started

scores will allow us to review historical data (at least 12 months) to identify

practice changes due to Joint Commission recommendation to not hang

phenylephrine in advance of the case

free text note- would need to standardize documentation in order to capture

reason for GA consistently in MPOG

iii. Most sites in MPOG show 0-10 GA cases for cesarean delivery per month over

the last year- individual case review of the few cases/month could help identify

trends for reason for conversion to GA

iv. See slides for preliminary data for GA conversion rates across MPOG sites

(anonymized)

reason for GA conversion may simply be that there isn’t enough time to get

rate is approximately 12%. We created three different buckets for reasons for

conversion to GA so we can track this better. The reasons we developed for

documenting these conversion reasons in Epic are:

1. Patient comorbidities

2. Failure of regional technique

3. Failure to use regional technique due to timing

iv. Wandana Joshi (Dartmouth): We are interested in this measure too. Are other

sites looking at DPE rates?

institution for a while and it did not make a difference in failure rate or quality

of the block. We are not a training institution though, so the majority of our

viii. Nirav Shah (MPOG Director): We have a need for standardization of

documentation around reasons for conversion to GA. If others can share

screenshots of their build, we can work with Epic to share the code and try to

standardize the documentation

ix. Joshua Younger (Henry Ford Detroit): Some of the issues may be coming from

not enough frequent rounding on the floor to assess the epidural. If you have a

method of documenting that you checked in with the patient and checked the

level, you may be able to better find epidurals that stopped working a few hours

prior. I would like to see some sort of measure to see how often we are

checking in on the labor floor

with contraction, Dermatome block right/left, an original bromage scale right

and left

xi. Antonio Gonzalez (Yale): When we look at failed epidural catheters for c-

sections, looking at how many boluses the patient got and how comfortable the

patient was after block was placed. If the patient got more than 3 or 4 boluses,

we assess the record to see if we missed something with the patient care. The

epidural likely should have been replaced. For GA, another benchmark should

be looking at elective c-sections (which should have a much lower rate)

compared to general anesthesia for urgent or emergent cases.

xii. Carlos Delgado (University of Washington): At UW, we have stipulated q2h