ASPIRE Obstetric Anesthesia Subcommittee Meeting
October 20, 2020
Agenda
• Announcements
• OB Specialty Dashboard
• July 2020 Meeting recap and follow up
• BP 04 update
• GA 01 General Anesthesia for Cesarean Delivery Measure
• Plans for 2021!
Announcements
• Please update Zoom name if needed
• 2021 Meeting Dates
– February 3
rd
, 1pm EST
– May 5
th
, 1pm EST
– August 4
th
, 1pm EST
– November 3
rd
, 1pm EST
• Basecamp Forum
– Please email coordinating center if you
are not on the basecamp OB forum
New OB Dashboard
• Available via “Dashboard Beta” link on MPOG.org
Automatic
filtering applied
Data reflects
only the OB
population
Subset of all
measures shown
which include OB
Additional filters
are available
Same filter applies
to measure
breakdown page
Only OB Data is
included
Inline case
drilldown
information
July 2020 Meeting Recap
• AKI 01- Postoperative AKI
– Interest in tracking patients with severe pre-
eclampsia
– Additional row added to case report tool and web
case viewer
New column in
Case Report
Tool
Info available in
Web Case Viewer
July 2020 Meeting Recap
• BP 04 Hypotension during Cesarean Deliveries measure discussed in meeting and via
basecamp forum
• Takeaways:
– Include pre-eclampsia and HELLP syndrome patients in the measure
– Flag cases with SBP<90 for > 5 minutes for all patients (pre-eclampsia, HELLP included)
– Include scheduled and conversion cases
– Include urgent and emergent cesarean deliveries
– Use oxytocin administration start time (bolus or infusion) if neonate delivered is not available
• BP 04 remains in development
BP 04- Hypotension During Cesarean Deliveries
70.0%
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
BP 04 Prelim Performance
BP 04 Development Questions
Exclusions:
– Cesarean delivery patients undergoing general anesthesia- determined using Anesthesia Technique-Neuraxial
MPOG phenotype
– Patients undergoing cesarean section with hysterectomy (CPT: 01969)
– Emergency cesarean delivery with diagnosis of placental abruption (ICD-10: O45*)
– Rupture of uterus (spontaneous) before onset of labor (ICD-10: O71.0)
– Newborn affected by intrauterine blood loss from ruptured cord (ICD-10: P50.1)
– Abnormal uterine or vaginal bleeding, unspecified (ICD-10: N93.9)
– Placenta previa with hemorrhage, third trimester (ICD-10: O44.13)
– Hemorrhage from placenta previa, antepartum condition or complication (ICD-10: 641.13)
– Hemorrhage from placenta previa, delivered, with or without mention of antepartum condition (ICD-10:
641.11)
Keep this
exclusion?
Currently looks 30 days
before to 7 days after
BP 04 Development Questions
• Complex phenotype development
– OB Anesthesia Start Phenotype
– Neuraxial Start Time Phenotype
– Cesarean Delivery Start Time Phenotype (for conversion cases)
– These phenotypes will support future OB measure development
• Will post to forum if more questions arise
• Currently validating the BP 04 data
Call for Measure Survey Results
• Review Call for Measure Survey Results
#1: Prolonged hypotension before cesarean delivery: 4.38/5.00 IN DEVELOPMENT
#2: General Anesthesia Rate for Cesarean Delivery: 3.63/5.00
#3: Non-opioid adjunct used for post cesarean delivery pain: 3.38/5.00
#4: Antibiotic Timing for cesarean delivery: 3.25/5.00 DONE
- Opted to add Antibiotic Selection Measure to assess azithromycin use
#5: First temperature in PACU for cesarean delivery: 3.13/5.00
#6: PONV in PACU for cesarean delivery: 3.13/5.00
• Next measure: General Anesthesia Rate for Cesarean Delivery?
General Anesthesia Rate for Cesarean Delivery
• Around 7% of cesarean deliveries in MPOG have general anesthesia
– According to SOAP, <5% of cesarean deliveries in the US use general anesthesia
– Hand review of cases have around 18% with a discernable reason for GA in a free
text note
• Need for standardized documentation of reason for GA
• May require individual case review at the site level to find cause for GA
– Most sites in MPOG showing 0-10 general anesthesia cases for cesarean deliveries
per month over the last year
General Anesthesia for Caesarean Delivery Rates by Site (2015-2020)
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
Rate
General Anesthesia Rate for Cesarean Delivery
Measure Development Questions:
•
Exclude cesarean deliveries with hysterectomy?
•
Exclude cesarean deliveries with other procedures list (ex: appendectomy, ostomy,
etc)?
•
Which providers should be notified/listed in association with the case?
Planning for 2021
• Please keep an eye out for upcoming survey
– General subcommittee feedback
– Call for measures for 2021
THANK YOU!
Brooke Szymanski-Bogart, MSN,
RN, CPN
MPOG QI Coordinator
bmiszy@med.umich.edu
Nirav Shah, MD
MPOG Associate Director
nirshah@med.umich.edu
