Quality Committee
Meeting
May 24, 2021
Agenda
Announcements & Upcoming Events
Measure Update Pain 02
Measure Review
TRAN 01 Review - Dr. Linda Liu - UCSF
TRAN 02 Review - Dr. John Trummel - Dartmouth
PONV 01 measure updates - Time Permitting
Conclude
Meeting Minutes
March 2021
Roll Call – via Zoom or
contact us
Announcements
Featured Member May and June 2021:
Dr. Gary Loyd
Welcome New Sites:
Metro Health Grand Rapids
Froedtert & Medical College of Wisconsin
Upcoming Events
Friday, July 16, 2021, ASPIRE Collaborative Meeting - virtual
Friday, October 8, 2021, MPOG Retreat - hopefully in person + virtual
OB Subcommittee
Updates
Kate Buehler
OB Subcommittee Updates
• May 5th meeting minutes & slides now available
• Neuraxial anesthesia type added to the BP 04 OB Case Report tool
– Request per subcommittee to enable sites to filter out results by neuraxial type
● Updating GA 01 (General Anesthesia used in Cesarean Delivery) to highlight cases where
neuraxial anesthesia is documented prior to conversion to general anesthesia
● Plan to create new temperature outcome measure (TEMP 05 OB) - Hypothermia (<36 C)
in PACU
OB Subcommittee Updates
• If your site is doing any work around standardizing documentation of reason for
conversion to GA for cesarean delivery- please contact the Coordinating Center.
• Please review the OB dashboard for BP 04 and GA 01. Consider if the results accurately
reflect your practice and if the appropriate cases are being excluded
Next meeting: August 4th 1pm EST
For any questions regarding the OB Subcommittee or feedback on the OB measures,
please contact: Brooke Szymanski-Bogart bmiszy@med.umich.edu
Pediatric Subcommittee
Updates
Meridith Bailey
MPOG Pediatrics Update
• Last meeting was May 19th
– 33 members in attendance!
• Finalized PONV risk factors for patients 3-17y
– Females (≥ 12y)
– Inhaled anesthetic duration ≥ 30 minutes
– Hx of PONV (personal or first-degree relative)
– At Risk Surgery (Strabismus, adenotonsillectomy, tympanoplasty)
– Postoperative long-acting opioids (Administered after Induction)
• Reviewed TRAN-01 and TRAN-02 measure criteria related to patients < 18y
TRAN-01/02 Pediatric Recommendations
• 1 ‘unit’ transfused definition = 15cc/kg
• Massive Transfusion/blood loss: Total transfused volume (or EBL) of 40cc/kg
• Include patients ≥ 6mo.
• Exclusions
– Cardiac bypass cases (and ECMO)
– All obstetric procedures
– Revisit Burn case exclusion or refine to TBSA.
• TRAN 02 Success
– If No Hb/Ht checked within 18 hours of Anesthesia End, the case should be flagged for systematic review
PAIN 02 Measure Update
PAIN 02
Percentage of patients ≥ 18 years old who receive a non-opioid adjunct preoperatively
and/or intraoperatively (at least one non-opioid adjunct - medication, regional block,
neuraxial block, or local injection)
Released to dashboard 5/4/2021
Modified measure from originally approved specification by removing dexmedetomidine
from list of non-opioid analgesic medications based on POFA study
Measure Review
Measure Reviewers - Thank You
Linda Liu, MD
UC San Francisco
John Trummel, MD, MPH
Dartmouth-Hitchcock
Masakatsu Nanamori, MD
Henry Ford Health System
TRAN 01: Summary of modifications proposed
1) 350 cc/unit definition is not consistent across centers, our cases have failed at
transfusion #4 (MPOG thinks it’s 3.4 units) because we use 300 cc/unit - Liu
2) Is it possible to develop exclusion criteria of red blood transfusion associated
with profound or prolonged intraoperative hypotension requiring a vasopressor
use or sign of the end organ damage? - Nanamori
3) There are considerations made for hemodynamics for C/S patients (HR>110, SBP<85,
DBP<45, or O2Sat <95%) Should there also be considerations for other surgical
patients who are hemodynamically unstable? (ie: where the successive unit is given
without stopping for a hct check)? Or else if 2 units are given within 15-30 minutes,
they are considered as passed based on 1 prior hct/hgb check? - Liu
4) Consideration for separation of cardiac and non-cardiac cases? - Nanamori
TRAN 01 Measure Vote
Please remember: 1 vote per institution
TRAN 02: Summary of modifications proposed
If No Hb/Ht checked within 18 hours of Anesthesia End, the case should be flagged for
systematic review - Shah (based on feedback from Pediatric Subcommittee)
TRAN 02 Measure Vote
Please remember: 1 vote per institution
PONV Measure Updates
New Guidelines Released
● Fourth Consensus Guidelines for the Management of Postoperative Nausea and
Vomiting released August 2020 in Anesthesia and Analgesia
● New guidelines provide updates to both risk factors and prophylaxis
recommendations for adults and pediatrics
● MPOG Pediatric Subcommittee creating new measure for pediatrics PONV prophylaxis
● Need feedback from Quality Committee for new adult prophylaxis measure
● Consider new measure rather than revision to old measure to enable comparison
between two processes and impact on outcome (PONV 03)
Background: PONV 01 Performance
PONV 03 Performance (Increased Incidence)
PONV 03b Performance
Inclusion/Exclusion Criteria
OLD (PONV 01 - 2018) from MIPS Measure
Inclusion
● Received an inhalational general anesthetic
● Has ≥ 3 risk factors for PONV
Exclusion
● Patients less than 18 years old
● Patients transferred directly → ICU
● Liver or Lung Transplants
● CPT 00452 (no longer used for clavicle surgery)
● Procedures on the Neck
● Intrathoracic Procedures (CPT 00561)
● Cardiac procedures (CPT 00562, 00563, 00567)
● CPT 00622 (no longer used for thoracolumbar sympathectomy)
● CPT 00634 (no longer used for chemonucleolysis)
● Radiology Procedures (CPT 01916; 01922)
● Cardiac Catheterization procedures (CPT 01920)
● Burn Debridement (CPT 01953)
● Organ Harvest (CPT 01990)
● Anesthesia for other procedures/block only (CPT 01991, 01992,
01996, 01999)
● Labor Epidurals (CPT 01958, 01960)
UPDATE (2021)
Inclusion
● Patients ≥ 18 years old
● Received general anesthesia (inhalational or TIVA)
Exclusion
● Patients < 18 years old
● Patients transferred directly → ICU
● Labor Epidural cases
● Organ Harvest (CPT 01990)
● Cases performed without general anesthesia
○ Neuraxial only
○ Regional only
○ MAC/sedation cases
Gan et al, 2020
Success Criteria
OLD (PONV 01)
● Patients with 3 or more risk factors receive
combination therapy consisting of at least
two prophylactic pharmacologic anti-emetic
agents of different classes preoperatively or
intraoperatively
NEW (PONV 04)
● Patients with 1 or 2 risk factor(s) receive
combination therapy consisting of at least two
prophylactic pharmacologic anti-emetic agents
of different classes preoperatively or
intraoperatively.
● Patients with 3 or 4 risk factor(s), receive three
or more prophylactic pharmacologic antiemetic
agents from different classes preoperatively or
intraoperatively.
Prophylaxis Considerations
OLD (PONV 01-2018):
● NK-1 Receptor Antagonists
● 5-Hydroxytryptamine (5-HT3) Receptor
Antagonists
● Glucocorticoids
● Phenothiazines
● Butyrophenones
● Antihistamines
● Anticholinergics
● Prokinetics (metoclopramide)
● Other:
○ Propofol (infusion only)
NEW (PONV 04 - 2021):
● NK-1 Receptor Antagonists
● 5-Hydroxytryptamine (5-HT3) Receptor
Antagonists
○ Remove Dolasetron?
● Glucocorticoids
● Phenothiazines
● Butyrophenones (rename Antidopaminergics)
○ Move metoclopramide to this category
○ Add perphenazine?
○ Keep Haloperidol?
● Antihistamines
● Anticholinergics
● Other
○ Propofol (infusion only)
○ Continue to exclude midazolam?
○ Continue to exclude gabapentinoids?
● Add non-pharmacologic section
○ Include acupuncture (PC6 stimulation)
Another consideration - should we match the inclusion and
exclusion criteria for the process and outcome measure
PONV 01 Exclusions
● Patients transferred directly → ICU
● Liver or Lung Transplants
● CPT 00452 (no longer used for clavicle surgery)
● Procedures on the Neck
● Intrathoracic Procedures (CPT 00561)
● Cardiac procedures (CPT 00562, 00563, 00567)
● CPT 00622 (no longer used for thoracolumbar
sympathectomy)
● CPT 00634 (no longer used for chemonucleolysis)
● Radiology Procedures (CPT 01916; 01922)
● Cardiac Catheterization procedures (CPT 01920)
● Burn Debridement (CPT 01953)
● Organ Harvest (CPT 01990)
● Anesthesia for other procedures/block only (CPT 01991,
01992, 01996, 01999)
● Labor Epidurals (CPT 01958, 01960)
PONV 03/03b Exclusions
● Patients transferred directly → ICU
● Liver or Lung Transplants
● Organ Harvest (CPT: 01990)
● Labor epidurals
● MAC cases?
Next steps
Create Measure Specification
Circulate among Quality Committee for feedback
Review at next Quality Committee meeting (July)
Vote to approve
Thank You
