ASPIRE Obstetric Anesthesia Subcommittee Meeting
February 3, 2021
Agenda
• Announcements
• October 2020 Meeting recap
• ABX 01 Provider attribution discussion
• BP 04 Prelim data review
• GA 01 Measure spec discussion
• 2021 Planning Survey Results and next steps
Announcements
• 2021 Meeting Dates
– May 5
th
, 1pm EST
– August 4
th
, 1pm EST
– November 3
rd
, 1pm EST
• Obstetric Anesthesia Type Phenotype
Completed
October Meeting Recap
• BP 04: Prolonged Hypotension Measure update and discussion
• GA 01: General Anesthesia for Cesarean Delivery Measure
– Unable to capture reason for GA in MPOG Data
– Will require review at the local level
– Number of cases per month is small
October Meeting Recap
• OB Dashboard
– Please reach out with any feedback!
• Steps to access OB Departmental Dashboard
– Change ‘Entity’ in upper left corner to your institution
– Choose ‘Dashboards’, then ‘Obstetric’ from banner along the top
ABX 01
• Percentage of cesarean deliveries with documentation of antibiotic administration initiated
within one hour before surgical incision
• Currently does not have provider attribution
• Which providers should be notified/listed in association with the case (if any)?
BP 04
• Hypotension (SBP <90) during cesarean delivery between neuraxial start and neonate
delivered
• Final validation in progress. All scores >90% across MPOG
• BP 04 will be available on departmental level OB Dashboards soon
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
GA 01 – Spec review
• Description: Percentage of cesarean delivery cases where general anesthesia was
used
• Measure Time Period: Anesthesia Start to Anesthesia End
• Inclusions: All cesarean delivery cases (scheduled or conversion)
• Exclusions:
– Cesarean hysterectomies – Keep exclusion?
– Non-cesarean delivery cases
– Add any more exclusions?
• Success: Cesarean delivery completed without use of general anesthesia
GA 01
• Responsible Provider: Which providers should be notified/listed in association with the case?
• Threshold: Should a success threshold be added to this measure?
0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
16.00
GA 01 Preliminary Scores (% flagged)
2021 Planning Survey Results
• 9 responses – Thank you!
• Interest from the committee for measures on these topics:
– PONV
– PONV in PACU
– PONV Prevention (antiemetics administered)
– First temp in PACU following cesarean delivery
– Non-opioid adjunct for cesarean delivery
2021 Planning Survey Results
PONV in PACU Following
Cesarean Delivery
First temperature in PACU
following cesarean delivery
Non-opioid adjunct used for post
cesarean delivery pain
67% very important
56% very important
44% very important33% extremely important
2021 Planning Survey Results – “Write Ins”
Suggestion
Rating
Rate of epidural replacement in labor
Very important
Need for blood product transfusion if intra
-procedure PPH
Very important
Regular patient checks for
parturients with labor epidurals
Extremely important
Failed extension of epidural for CD
Very important
Accidental Dural Puncture / PDPH
Extremely important
Adherence to ERAS
Very important
incidence of
dural puncture with epidural
Extremely important
Antiemetics
administered preop/intraop
Very important
ERAS milestones (time to d/c
foley, time to ambulation)
Very important
Appropriate addition of azithromycin for cesarean sections
Extremely important
GA for elective and urgent/emergency cases
Extremely important
Pain
>= 3 during labor with epidural (within 60 minutes of initiation)
Extremely important
Phenylephrine infusions and regulatory requirements
Very important
incidence of
bloodpatch
Extremely important
Interest from the committee for
measures on these topics:
• PONV (Prevention or in PACU)
• First temp in PACU following cesarean
delivery
• Non-opioid adjunct for cesarean
delivery
SOAP ERAC Elements
•
Prevent and treat spinal anesthesia
induced hypotension (BP04 in dev)
•
Antibiotic prophy (ABX 01)
•
IONV and PONV prophy and
treatment
•
Maintain normothermia
•
Initiate multimodal analagesia
•
IV fluid optimization – limit IV fluids to
<3 L for routine cases
•
Optimal uterotonic administration- use
the lowest effective dose necessary
•
Promote breastfeeding and maternal-
infant bonding
•
Delayed cord clamping
Existing related MPOG Measures
• TEMP 01: Percentage of cases that active warming was administered by the anesthesia
provider
– Cesarean deliveries are included
– Labor epidurals are excluded
– Success: documentation of an active warming device (including fluid warmer for CD) OR temp ≥ 36.0 within
30 minutes before case end
• TEMP 02: Percentage of cases with at least one core temp documented intraoperatively for
any patient receiving a general anesthetic
– Cesarean deliveries included, but this measure is limited to only those that received general anesthesia
– Cases <= 30 minutes are excluded
• TEMP 03: The percentage of cases with hypothermia (< 36) within 30 minutes before or 15
minutes after anesthesia end
– Limited to cases >60 minutes in duration
– Excludes labor epidurals and labor epidurals converted to cesarean deliveries
Proposed OB Temp Measure
• “TEMP 05-OB” First temperature in PACU following cesarean deliveries
Existing related MPOG Measures
• PONV 01- The percentage of cases with appropriate antiemetic administration for
postoperative nausea and vomiting prophylaxis
– Inclusions: patients receiving inhalational general anesthesia with three or more risk factors for PONV
– Include cesarean deliveries, but is limited to only those that received inhalational general anesthesia
• PONV 03- Percentage of patients who undergo a procedure and have a documented
nausea/emesis occurrence OR receive a rescue antiemetic in the immediate postoperative
period.
– Includes cesarean deliveries
– Excludes labor epidurals
– Modifications for OB?
Proposed next measure
• Which measure is the top priority for development in 2021?
– “PONV 04- OB” PONV in PACU
– Include antiemetic administration as criteria for flag?
– Merge into PONV 03?
– “TEMP 05-OB” First temperature in PACU following cesarean deliveries
– “PAIN 02 – OB” Multimodal analgesia for cesarean deliveries
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
