Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE)

Quality Committee Meeting Notes – Monday, November 28, 2022

Attendance:

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 September 26, 2022 meeting approved- minutes and recording posted on the

website for review

3. Announcements

○ MPOG Featured Member (November- December 2022): Meredith Hall, MD - Bronson Battle

○ TEMP-07 Released!

4. Measure Review: MED-01, Karen Domino, MD, MPH - University of Washington

○ DISCUSSION:

■ See presentation slides for additional literature included as part of Dr. Domino’s review.

■ Recommendations per Karen Domino’s review:

● Modify parameter to include PACU

● Reduce threshold to lower amount

● Consider elimination of flumazenil pending MPOG assessment of use

■ Patrick Henson (Vanderbilt) via chat: Agree with extending into PACU and agree that

flumazenil use is probably not worth tracking

● Gaurav Katta (Henry Ford):I think we should have everyone as the responsible provider.

The rate is so low I think it's wise to make everyone aware.

● Alvin Stewart (University of Arkansas) via chat: But the pacu provider is not documented

on a timeline. So that person will not be notified. The department quality officers would

like an overall measure.

○ Nirav Shah: Only intraop providers would be made aware given the MPOG

● Marc Pimentel (BWH) via chat: Agree - the outcome is serious enough that all providers

should be listed as responsible providers. Maybe administration of naloxone in the PACU

can be called out separately

30-60 minutes in PACU, (3) after 60 minutes into PACU stay

○ Gaurav Katta (Henry Ford) via chat: If we make PACU a separate measure we may as

● Shafeena Nurani (Corewell Health-East Troy) via chat: I like the idea of making PACU use

a separate measure

● Karen Domino (University of Washington): Not sure we need to break out PACU

separately- more important that people look at the measure since incidence is so low.

● Michael Andreae (UUtah) via chat: Is Naloxone at low dose given for itching when no IV

opioids are in play? Epidural with fentanyl and local, itching prophylaxis with low dose

○ John LaGorio (Mercy Muskegon): When educating providers about this measure I

○ MED 01 VOTE:

Conclusion: Make the following revisions to MED 01

○ DISCUSSION:

■ Marc Pimentel’s recommendation to QC:

● Modify measure to account for PACU hold scenarios where there aren’t BPs recorded

while waiting for PACU bed

■ Patrick Henson (Vanderbilt): Should be charting “Anesthesia end” if on PACU hold, correct? I

do like the idea of PACU hold event tho

■ Nirav Shah (MPOG Quality Director): If on hold for PACU bed, should we still be monitoring

the patient? Maybe not every 5 minutes but is there some criteria we should apply to

support some monitoring while ‘on hold?’

■ Gaurav Katta (Henry Ford): If you are billing for anesthesia time (have a provider

handover team has assumed continuous care of the patient

● Diego Bauza (Cornell): Do we have any indication of how many cases 'PACU hold' would

apply to? If we are still billing for anesthesia time during PACU hold, would it be

appropriate to change the timing of VS?

○ Dan BIggs (UOklahoma): We at our institution treat it just as a regular timing

● Nirav Shah (MPOG Quality Director): Coordinating Center can assess if PACU hold events

are submitted to MPOG consistently- if so, can account for the % of flagged cases during

PACU hold time period vs. other time periods during case

○ BP-02 VOTE:

Conclusion: Update BP 02 to break out PACU Hold cases - still include in the measure but

report the number of cases flagged due to PACU Hold gaps vs. gaps during other portions of

the case