Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE)
Quality Committee Meeting Notes – Monday, September 27, 2021
Attendance:
Agerson, Ashley (Spectrum)
Mack, Patricia (Weill Cornell)
Applefield, Daniel (St. Joseph Oakland)
Malenfant, Tiffany (MPOG)
Bailey, Meridith (MPOG)
Manders, Larry (Beaumont Taylor)
Berndt, Brad (Borgess)
Mango, Scott (MidMichigan Midland)
Biggs, Dan (Oklahoma)
McKinney, Mary (Beaumont Dearborn / Taylor)
Boutin, Jimmy (Henry Ford Wyandotte)
Mentz, Graciela (MPOG)
Buehler, Kate (MPOG)
Milliken, Christopher (Sparrow)
Chen, Lee-Lynn (UCSF)
Nakai, Harrison
Clark, David (MPOG)
Nanamori, Masakatsu (Henry Ford Detroit)
Cohen, Bryan (Henry Ford Detroit)
Obembe, Samson (Weill Cornell)
Collins, Kathleen (St. Mary Mercy Livonia)
Owens, Wendy (MidMichigan - Midland)
Coleman, Rob (MPOG)
Pace, Nathan (Utah)
Colquhoun, Douglas (MPOG)
Palmer, Marissa (MidMichigan - Midland)
Coons, Denise (Bronson)
Pardo, Nichole (Beaumont)
Cuff, Germaine (NYU Langone)
Poindexter, Amy (Holland)
Dewhirst, Bill (Dartmouth)
Pywell, Carol (Beaumont Troy)
Domino, Karen (Washington)
Qazi, Aisha (Beaumont Troy)
Drennan, Emily (University of Utah)
Quinn, Cheryl (St. Joseph Oakland)
Dubovoy, Tim (Michigan)
Riggar, Ronnie (MPOG)
Durand-Boettcher, Colin (Wisconsin)
Rozek, Sandy (MPOG)
Everett, Lucy (MGH)
Ruiz, Joseph (MD Anderson)
Finch, Kim (Henry Ford Detroit)
Saad, Manal (MPOG)
Fisher, Garrett (MidMichigan)
Schonberger, Rob (Yale)
Goatley, Jackie (Michigan Medicine)
Scranton, Kathy (Mercy St. Mary)
Harwood, Timothy (Wake Forest)
Shah, Nirav (MPOG)
Heiter, Jerri (St. Joseph A2)
Smith, Susan (St Joes)
Horton, Brandy (A4)
Stewart, Alvin (UAMS)
Hurwitz, Rachel (MPOG)
Szymanski-Bogart, Brooke (MPOG)
Janda, Allison (MPOG)
Trummel, John (Dartmouth)
Johnson, Rebecca (Spectrum & Metro)
Tyler, Pam (Beaumont Farmington Hills)
Kaper, Jonathan (Beaumont Trenton)
Vaughn, Shelley (MPOG)
Kenron, Dan (OHSU)
Vishneski, Susan (Wake Forest)
Khan, Meraj (Henry Ford Macomb)
Wren, Jessica (Henry Ford Wyandotte/Macomb)
Lacca, Tory (MPOG)
Zittleman, Andrew (MPOG)
Lewandowski, Kristyn (Beaumont)
Lins, Steve (Bronson)
Lockwood, Holly (Henry Ford Allegiance)
Loyd, Gary (Henry Ford)
Agenda & Notes
1) Roll Call: Will contact QI Champions and ACQRs directly to inquire about participation status if
missing. Other participants can review meeting minutes and contact the Coordinating Center if they
are missing from the attendance record.
2) Minutes from July 26, 2021 meeting approved- minutes and recording posted on the website for
review
3) Announcements & Updates
a) Featured Member September and October 2021 – Jessica Wren, Henry Ford Macomb and
Wyandotte
b) ACQR Retreat held on September 17th at the DoubleTree hotel in Ann Arbor
i) 20 ACQRs in attendance: 10 virtual/10 in-person
ii) Great opportunity for Michigan sites to collaborate
iii) Presentation materials available on MPOG website
c) MPOG Application and Database Upgrade to be released the week of October 18th
i) MPOG Technical team to send package to site technical teams to apply to their local MPOG
Database
ii) Release notes will be released with the upgrade package
d) QI Needs Assessment survey distributed last week to all Michigan ACQRs and Quality Champions
i) Seeking to understand what work is already being done in your departments and what
ASPIRE may be able to help with
ii) Contact Coordinating Center if interested in partnering on a QI project for your site
iii) Submit survey by October 8th
4) Upcoming Events
a) MPOG Retreat: October 8, 2021
i) Manchester Grand Hyatt, San Diego, California
ii) Please register if planning to attend
iii) Keynotes:
(1) Eric Topol, MD
(2) Michelle Mello, PhD, JD
iv) Afternoon session: After QI update, small group discussions on a variety of topics. Those
in-person will divide up. We will have a virtual small group session for those interested as
well
b) Quality Committee Meetings via Zoom
i) Monday, November 22, 2021
c) 2022 Calendar now posted on the MPOG website: mpog.org/calendar/
5) Subcommittee Updates
a) OB Subcommittee Updates shared: see posted slides for more information
i) 2 new OB measures have been released to the ‘All Measures’ and ‘Obstetric’ Dashboards
(1) TEMP 05-OB
(2) GA 02-OB
b) Cardiac Subcommittee Updates shared: see posted slides for more information
i) Seeking perfusionists who would like to join the subcommittee to provide input for the new
on-bypass hyperthermia avoidance measure. Please contact ajanda@med.umich.edu if
interested!
6) Measure Updates and Feedback
a) PAIN 01 and 02 (use of non-opioid adjuncts) attribution (Zoom recording discussion 1017-1020)
i) Several sites wish to include measure performance as part of provider emails
ii) Inaccurate to assign attribution related to a specific time period (induction, emergence) due
to variation in administration of adjuncts
iii) Decision: Assign attribution to all provider s providing care
iv) Will not affect sites who wish to view this measure at an institutional level only
b) Measure Review- NMB 02 (Dr. Tim Dubovoy, Michigan Medicine)
i) Feedback from Measure Reviewer
ii) Zoom Recording available to hear full discussion (Zoom recording discussion 1020-1048)
iii) Recommendation from reviewer to continue measure with modifications:
(1) Remove cardiac exclusion: per cardiac subcommittee
(2) Remove 3 hour period of no NMB as marker of success
(3) Remove 2 hour period of no NMB as marker of success: per Pediatric Subcommittee
(4) Remove defasciculating dose exclusion
(5) Modify last sentence of rationale to read:
(a) “Due to variability in duration of muscle relaxants, we recommend that
pharmacological reversal is administered when any non-depolarizing neuromuscular
blockers are administered unless full recovery is confirmed with a ratio of ≥0.9 by
quantitative monitoring.”
iv) Chat comments:
(1) Karen Domino (University of Washington): The ASA is currently working on a guideline re
measurement and reversal of neuromuscular blockade. Some local institutional policies
do not recommend reversal of NMB if the patient has already spontaneously recovered
measured by quantitative monitoring (≥0.9)
(2) Meridith Bailey (MPOG Coordinating Center): Peds Subcommittee reviewed this measure
last month and consensus among the group was to remove the 2 hour duration criteria
(3) Rob Schonberger (Yale): Hi all, this is Rob - regarding cardiac exclusion, I agree with prior
points. Have a manuscript under review presently showing more rapid cticu extubation
with protocolized reversal. So can we limit it if there is documented spontaneous
reversal?
(4) Tim Harwood (Wake Forest): 2-3 hours should cover ESRD patients
v) Vote:
(1) Continue as is (3/30: 10%)
(2) Modify (25/30: 83%)
(3) Retire (2/30:7%)
vi) Conclusion:
(1) Remove cardiac exclusion: per cardiac subcommittee
(2) Remove 3 hour period of no NMB as marker of success
(3) Remove 2 hour period of no NMB as marker of success: per Pediatric Subcommittee
(4) Modify defasciculating dose exclusion criteria to include weight-based component
and/or case time
c) Measure Review- NMB 01 (Drs. Peter Panagopoulos & Alvin Stewart)
i) Feedback from Measure Reviewers
ii) Zoom Recording available to hear full discussion (Zoom recording discussion 1049-1059)
iii) Recommendation from reviewers to continue measure as is
iv) Chat comments:
(1) Carol Pywell (Beaumont Troy): At Beaumont Troy we have an Epic row TOF% and we do
have data integration capability.
(2) Patricia Mack (Cornell): Cornell is integrated into EPIC
(3) Alvin Stewart (UAMS): We have the ability to do the same... a TOF% in a flowsheet.
v) Vote:
(1) Continue as is (26/31 84%)
(2) Modify (3/31 10%) - please email coordinating center (nirshah@med.umich.edu) with
your suggested modifications
(3) Retire (2/31 6%)
vi) Conclusion:
(1) Continue measure as is
(2) MPOG Coordinating Center to investigate current usage of quantitative monitoring
across MPOG sites (according to data submitted)
Meeting concluded at 11:00 am
