ASPIRE Quality Committee
Meeting
April 27th, 2020
Agenda
• Current Events
• Upcoming events
• Welcome University of Chicago!
• Updates
• April Upgrade
• Dashboard Update
• Peds Subcommittee
• OB Subcommittee
• Proposal: Cardiac Subcommittee
• Measure Updates and Discussion
• SSI measure
• In hospital mortality measure
• Hyperglycemia treatment
Thank You for all that
you have been doing
Meeting Minutes
February 2019
Roll Call – via webex or
contact us
2020 Quality
Committee
Meetings on
Monday
Upcoming Events
First, thanks to our invited speakers
for the cancelled March meeting
Tom Varghese, MD Dan Clauw, MD Eve Kerr, MD
ASPIRE Summer Meeting
July 17
th
2020
Mark your calendars and
keep your fingers crossed
April Upgrade: Case Viewer Changes
● Original Case Viewer officially retired – replaced by new Case Viewer
● *NEW* Case Viewer User Guide available on the MPOG website
● Copy buttons for MPOG Case ID & MRN reinstated
● Added patient age filter on the Case Search page
● Notes section opens on the right side by default when you open a case now
● Date of death displays in banner, if available
April Upgrade: Case Validation Changes
• Sections were reordered by topic to assist case reviewers:
• Case Information
• Times
• Staff
• Physiologic
• Medications
• Labs
*Removed general anesthesia & preop medication questions
*Revised neuraxial/regional question
*Reworded some questions to make more clear
April Upgrade: Data Diagnostic Changes
• Added free text search
filter
• Updated aesthetic -
vertical guide allows for
easier data point
selection.
• “Diagnostic Executed On”
now includes time.
• Various bug fixes
April Upgrade: IM Assistant Changes
Sort by source
system and
module columns
Months with partial
data are indicated
with a half
green/half gray box
Application Updates
Dashboard 2.0
• Release by end of May
• Can use alongside existing dashboard
• Plan to retire old dashboard by MPOG retreat in October
ASPIRE Pediatric
Subcommittee Update
Pediatric Subcommittee Update
• Peds group met on April 21
st
– 30 Pediatric Anesthesiologists were in attendance
– Partnering with SPA Q&S Workgroup, established to inform the MPOG pediatric
subcommittee of best practices in pediatric anesthesia. First meeting October 2020 at
ASA-Washington, D.C.
– Liaisons: Brad Taicher (Duke) and Vikas O’Reilly-Shah (Seattle Children’s)
– UM Peds Quality Champion – Bishr Haydar and Lisa Vitale
• Temperature Management Measure Criteria Confirmed (TEMP-04-Peds)
– Description: Percentage of patients < 18 years old who undergo any procedure greater
than 30 minutes whom have a median core temperature < 36
o
C (96.8
o
F) or nadir temp <
35
o
C (95
o
F)
– Measure Time Period: Patient in Room Patient out of Room
– Exclusions
– Cases < 30 minutes duration
– MAC/Sedation Cases
– Cases without documentation of a core or near core temperature route
– ASA 5 and 6
– Cardiac Surgery
Next Steps – Finalize Opioid Equivalency Specification
• Adding Tonsillectomy and/or Adenoidectomy for pediatric patients < 18yo
• Cases included: CPT code 00170 and with procedure text ‘tonsil’ and/or ‘adenoid’
Opioid Equivalency Dashboard (Peds)
• Informational measure only (no flagging of cases)
• Allows sites to compare practices across all other MPOG institutions
* Test data – not actual representation of practice
MPOG Obstetric
Anesthesia
Subcommittee
Obstetric Anesthesia Subcommittee Update
• Last meeting March 17
th
• Decision to proceed with ABX 01 (OB): Antibiotic Timing for Cesarean Deliveries
• Anticipated release: May 2020
• Discussion on BP 04 (OB): Prolonged Hypotension for Cesarean Deliveries
• Committee able to reach consensus on initial measure build
• Measure specification in progress
BP 04 OB: Hypotension during Cesarean Deliveries
Description:
• Total cumulative minutes of hypotension after spinal placement
• Total cumulative minutes of hypotension will be resulted for two time periods: spinal placement to delivery and
delivery through anesthesia end
• For patients with pre-eclampsia, hypotension is defined as >20% decline from baseline systolic blood pressure
• For patients without pre-eclampsia, hypotension is defined as SBP<90mmHg
Inclusions:
• All cesarean deliveries (Determined using the MPOG Obstetric Anesthesia Type phenotype) with neuraxial
anesthesia only
• Patients undergoing cesarean section with hysterectomy (CPT: 01969)
Exclusions:
• Cesarean delivery with general anesthesia only (without neuraxial anesthesia)- determined using Anesthesia
Technique-Neuraxial MPOG phenotype
• 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)
Cardiac Subcommittee Proposal
• Many current ASPIRE measures either exclude cardiac cases or do not
incorporate cardiac-specific factors
• We have brainstormed about potential cardiac ASPIRE measures but
want more input from the group
• Please join our the Cardiac Subcommittee!
• Contact Allison Janda (ajanda@med.umich.edu) or Nirav
(nirshah@med.umich.edu) if you wish to participate
Measure Updates
Surgical Site Infection (SSI 01)
In hospital mortality (MORT 01)
Surgical Site Infection Measure (SSI 01)
• Includes only cases that were present in both the MSQC and ASPIRE registries (denominator)
• Displays surgical site infection data (superficial, deep, organ space, and ALL)
• Using MSQC sample of cases
• SSI data abstracted by nurse abstractors in each participating site
• Will display the previous 12 month trend over time including risk-adjusted and non risk-adjusted
rates
• Refreshed quarterly (based on data integration schedule with MSQC)
• Ability to filter by surgical procedure (MSQC covers general surgery, vascular surgery, and
hysterectomy)
• Available at institution level only (not on provider emails), on new dashboard
• Opportunity for Quality Champions to review with ASPIRE process measures affecting surgical site
infection
• Can enable for sites submitting NSQIP data at quarterly intervals.
SSI Rate - Institutional Risk Adjusted Comparison
Description: The surgical site infection data below was provided by Michigan Surgical Quality Collaborative (MSQC) and includes only those cases
that matched to a case in the ASPIRE registry. Denominator = All MSQC cases that matched to an ASPIRE case; Numerator = Surgical Site
Infections as entered by an abstractor into the MSQC registry.
Measure Updates: In hospital mortality (MORT 01)
Description:
• Percentage of patients where inpatient death was reported within 30 days after
anesthesia
Post Anesthesia Mortality Rate:
# of cases where pt died within 30 days (exclude subsequent cases, only count one case per pt)
total # of cases performed
Inclusions:
• All patients undergoing anesthesia
Exclusions:
• ASA 6
• Anesthesia for access to central venous circulation (00536)
• Diagnostic imaging
Responsible Provider
• No provider attribution
Measure Discussion
Attribution for GLU 03 and GLU 04
Treatment of Hyperglycemia
GLU 03/04 Attribution
• Glucose 03 (perioperative hyperglycemia treated or rechecked) and Glucose 04
(perioperative hypoglycemia treated or rechecked) were introduced at the last Quality
Committee meeting and rolled out to institution level dashboards only
• Originally built with no provider attribution
• After single center review, we think alerting providers on flagged GLU 03/04 cases will be
helpful
• Proposed attribution strategy
– For cases that were flagged for GLU 03/04 preoperatively, notification would go to the provider signed in at
the start of the case
– For cases that were flagged intraoperatively, attribution would be to provider signed in when the treatment
or rechecking should happen (GLU 01/02 model)
– For cases that were flagged postoperatively, notification would go to the provider signed in at the end of the
case
New glycemic management measure -
Need your feedback
Description: Percentage of cases with perioperative glucose > 180 mg/dL with
administration of insulin within 60 minutes of original glucose measurement
Inclusions:
• All patients with glucose level greater than 180 mg/dL between Preop and PACU
Exclusions:
• ASA 5 and 6 cases
• Patients < 12 years of age.
• Glucose measurements > 180 mg/dL within 60 minutes before PACU out
• Outpatient cases with Anesthesia Start to Anesthesia end time less than 4 hours long
• Obstetric Non-Operative Procedures - CPT 01958, 01960, 01967
• Obstetric Non-Operative Procedures with procedure text: “Labor Epidural”
Responsible Provider: The provider signed in at the first administration of
insulin. If no insulin administration occurred, then the responsible provider is
the one signed in 60 minutes after the high glucose measurement
Feedback
• Does it make sense to separate glucose checking from hyperglycemia
treatment?
• If yes…
• Is > 180 mg/dL the right threshold?
• Is < 60 minutes the right response time?
• Additional exclusions?
• If yes…
• Should we also create a glucose checking measure?
• If no…
• Other ideas for glucose management measures?
Thank you
