ASPIRE Pediatric Subcommittee Meeting
April 21, 2020
Agenda
• Upcoming Events and Announcements
• December 2019 Meeting Recap
• Pediatric Measure Specification Review
• Temperature Management
• Non-Opioid Adjunct Administration/OME
2020 Pediatric
Subcommittee
Meetings
• July (Webex)
• October at ASA (in person)
• December (Webex)
Other 2020
MPOG Meetings
• MPOG Quality Committee
Meetings (web)
• April 27
th
, June 22nd , August 24
th
, October 26
th
• MPOG Annual Retreat
October 2
nd
, ASA-Washington DC
2019 Peds Subcommittee Meeting: Recap
• Meeting Minutes from December 2019 have been posted to the website
- Minutes
- Slides
• 23 Pediatric Anesthesiologists were in attendance
• 2020 plans: build 2-3 pediatric specific measures
- Temperature management
- Postoperative respiratory complications
- Add tonsillectomy and spine cases to oral morphine equivalency dashboard
- Intraoperative hypotension (informational measure)
SPA Quality & Safety Measure Workgroup
• Brad Taicher MD, PhD (Duke) presented an intro to MPOG at SPA
Q&S meeting in February.
• Proposed the formation of a metric workgroup within SPA Q&S to
help inform the MPOG subcommittee of best practices in pediatric
anesthesia.
• First in person workgroup meeting planned for October at ASA
• All members of the SPA Q&S committee are welcome to join,
regardless of involvement with MPOG.
Contact Meridith (Meridith@med.umich.edu) If interested in Joining.
Improved QI Dashboard – May 2020 Release
Measure Build
Temperature Management
Overview of Temperature measure updates…
• Focusing on hypothermia only more frequent among pediatric cases
• Low median temperature value will flag cases for review
– Consecutive temperature: difficult from a technical perspective.
– Average temperature not utilized since it can be impacted by over-warming a patient at the end of a case.
• Nadir temp < 35C will flag cases for review
– Seamon et al (2012) determined that a single intraoperative temperature measurement less than 35C
increased surgical site infection risk by 221% per degree below 35C (p=0.007)
• Time Period: Intraoperative
– Many patients are hypothermic for a significant duration of the procedure despite having a temperature >
36C postop.
– Baseline temperature and the first temp value postop will be listed for each case as information only to assist
in case review.
Measure Specification:
Intraoperative Temperature Management - TEMP 04 (Peds)
• Description: Percentage of patients < 18 years old who undergo any procedure greater than 30
minutes whom have a median core/near core body temperature < 36
o
C (96.8
o
F) or nadir temp < 35
o
C
(95
o
F)
• Measure Time Period: Patient in Room to Patient out of Room
• Algorithm for determining Measure Start/End Times
Measure Start Time
– Patient In Room. If not then,
– Induction End. If not then,
– Procedure Start. if not then,
– Anesthesia Start
Measure End Time
– Patient Out of Room. If not then,
– Procedure End. If not then,
– Anesthesia End
TEMP 04 (Peds)
• Core or Near Core Temperature Monitoring Includes:
– Pulmonary Artery, Distal Esophageal, Nasopharyngeal, Temporal, Tympanic, Bladder, Rectal Temperature,
Axillary Temperature (arm must be at patient side) or Oral Temperature
• Case Exclusions:
– ASA 5 and 6
– Cases < 30 minutes duration
– Unlisted Anesthesia procedure (CPT: 01999)
– Organ Harvest (CPT: 01990)
– Obstetric Non-Operative Procedures (CPT: 01958, 01960, 01967)
– Cardiac Surgery (CPT: 00561, 00562, 00563, 00566, 00567, 00580)
• Responsible Provider: Provider present for the longest duration of the case per staff role.
TEMP 04 (Peds)
• Success Criteria: The median temperature intraoperatively is ≥ 36 C (96.8F) or is the
nadir ≥ 35 C (95F).
• We will “clean” temperature values using the following artifact algorithm:
– Less than 32.0˚C (89.6F)
– Greater than 40.0˚C (104.0F)
– Any minute-to-minute jumps > 0.5˚C equivalent.
– Will account for initial warm up of probe placement
• Feedback requested: In addition to baseline temp and first postop temp, what
other data (if any) should be displayed as a “case detail”?
Next steps
• Publish temperature management measures
• Finalize specification for opioid equivalency – send to group and publish measure
• Send out specifications for proposed measures
Thank you
