Quality Committee
Meeting
November 28, 2022
10:00am - 11:00am Eastern Time
Meeting Minutes
September 2022
Roll Call – via Zoom or
contact us
Announcements
Chair: Dr. Jeremy Geiduschek
Quality Champion: Dr. Sally Rampersad
Principal Investigator: Dr. Vikas O’Reilly-Shah
Chair: Dr. Joseph Cravero
Quality Champion: Dr. Lauren Madoff
Principal Investigator: Dr. Morgan Brown
Chair and PI: Dr. Peter Rock
Quality Champion: Dr. Megan Anders
IT Champion:: Dr. Curt Bergstrom
Chair: Dr. Charles Whitten
Quality Champion: Dr. Trent Bryson
Principal Investigator: Dr. Kunal Karamchandani
IT Lead: Dr. Trent Bryson
2023 Meetings
Friday, April 21, 2023
MSQC/ASPIRE Collaborative Meeting
Michigan Union, Ann Arbor, Michigan
Friday, July 14, 2023
ASPIRE Collaborative Meeting
Henry Executive Center, Lansing, Michigan
Friday, September 15, 2023
ACQR Retreat
DoubleTree Hotel, Ann Arbor, Michigan
Friday, October 13, 2023
MPOG Retreat
San Francisco, California
TEMP 07 Released!
Percentage of patients, ≥ 18 years age, who undergo open cardiac
surgical procedures with cardiopulmonary bypass duration >120
minutes with recorded temperature > 37.5 degrees Celsius while on
bypass for over 5 consecutive minutes
• Counter measure to TEMP 06
• Inverse measure: lower score is better
• Please include perfusionists in your review of this data
• Cardiac Subcommittee received feedback from perfusionists in
creating this measure but not too late to provide additional
feedback!
Measure
Review
MED 01
Dr. Karen Domino
University of Washington
Avoiding Medication Overdose
ASPIRE MED-01
Karen B. Domino, MD, MPH
Professor
Anesthesiology and Pain Medicine
University of Washington, Seattle, WA
kdomino@uw.edu
24%
45%
16% 12%
32%
73%
• Patients with events in PACU are at several
fold-increased risk post-op.
• Depressed ventilation detected in PACU
persists for hours in general care units.
Weingarten TN: Anesthesiology 2022;137:735-741.
Risk Factors for Postop
Respiratory Depression
• OSA and sleep-disordered breathing
• Other patient factors:
• Advanced age (>60 years)
• Male sex
• ASA 3 or above
• CHF, pulmonary disease
• Impaired cognitive status
• Frailty
• Chronic opioid use
• GA higher risk than RA
• Longer-acting anesthetics and opioids
• Sedating non-opioids
24%
45%
16% 12%
32%
73%
• 335 hospitalized patients receiving opioids
• Monitored by SpO
2
and ETCO
2
for 24 hours
• Respiratory depression episodes – 46%
• Risk factors
• Age > 60 years
• Male sex
• Opioid naivety
• Sleep disorders
• Chronic heart failure
Khanna AK et al. Anesth Analg 2020:131:1012-1024.
Current MED-01 Measure
• Outcome Measure - % cases with naloxone or
flumazenil
• Measure Time – Anesthesia start to anesthesia end
• Inclusions – Intraop opioids or benzodiazepines
• Exclusions
• ASA 5 and 6 cases
• Naloxone or flumazenil before opioid/benzodiazepine
• Patients that are still intubated at anesthesia end
• No risk adjustment
• Success – naloxone or flumazenil was NOT required
Current Measure Parameters
Not
Appropriate
72%
• Responsible Provider – longest portion of
the case
• Threshold = 5%
• Opioids: morphine, fentanyl,
hydromorphone, sufentanil
• Benzodiazepines: midazolam, diazepam
• Reversal medications: flumazenil,
naloxone
Reported Incidence of
Naloxone Administration
Not
Appropriate
72%
• PACU: 0.25%*
• First 72 hours postop: 0.1%
+
• Med/surg ward: 0.12%
±
*Weingarten TN et al. J Anesth 2016:30:116-122.
+
Khelemsky et al. Pain Physician 2015:18:E827-E829.
±
Valencia Morales et al. Pain Medicine 2022;23:878-886.
Recommendations
Not
Appropriate
72%
• Modify parameter to include PACU
• Reduce threshold to lower amount
• Consider elimination of flumazenil
pending MPOG assessment of use
MED 01 Vote
1 vote/ site
Continue as is/ modify/ retire
Need > 50% to retire measure
Coordinating center will review all votes after
meeting to ensure no duplication
BP 02 Vote
1 vote/ site
Continue as is/ modify/ retire
Need > 50% to retire measure
Coordinating center will review all votes after
meeting to ensure no duplication
Hyperglycemia Measure Updates
GLU 01:
- Adding ‘pass’ criteria to consider cases that were administered insulin SQ within 120
minutes before the high glucose value (this change was already applied to GLU 03/05)
- Adding exclusion for cases with case duration ≤ 30 minutes
GLU 03 & GLU 05:
- Adding exclusion for cases with case duration ≤ 30 minutes
- Updated definition of preop start to default to 60 minutes before anesthesia start when
preop start is not documented
Adult PONV Prophylaxis Measure (PONV 05) Updates
Per previous Quality Committee recommendations:
- Added exclusion for TEE
- Added exclusion for endoscopy
- Includes all c-section patients, regardless of age
- Includes amisulpride as antiemetic
- Increases time period to 4 hours before c-section start time for cases that convert from
labor epidural
Additional recommendations:
- Exclude cases with duration ≤ 30 minutes
- Exclude MRI cases
*Performance scores minimally impacted by these changes: +/- 2.5%
Thank You!
TRAN 01 Measure Discussion
Percentage of cases with a blood transfusion that have a hemoglobin or hematocrit value documented prior to
transfusion.
● If multiple units are administered, documentation of a hemoglobin or hematocrit value must be present
within 90 minutes before each administration.
● Caveat: If the last hemoglobin or hematocrit drawn before the first transfusion is ≤ 5/16, a second unit could
be administered without rechecking hemoglobin/hematocrit.
Should we consider excluding cases where the post-transfusion hemoglobin/hematocrit is less then a certain
value?
