MPOG Pediatric
Subcommittee Meeting
February 16, 2022
Agenda
5 minutes
Announcements
10 minutes
December Meeting Recap
40 minutes
MPOG Peds 2022 Plans
Survey Results
Finalize Measure Build
5 minutes
Upcoming Events/Wrap up
Unblinded Data Review
Meeting Recap
December 2021
PONV Prophylaxis Measure Update (PONV-04-peds)
Now excludes ‘MAC/Sedation’ cases (ie natural airway cases)
Determined by the Anesthesia Technique: General phenotype
Value Definition
No No general, ETT, or LMA note and no sedative medications or inhaled anesthetics or paralytics
associated with the case.
General - both ETT and LMA There were ETT and LMA notes associated with this case.
General - ETT There was at least one ETT note, with another general or ETT note associated with this case. There
were no LMA notes.
General - LMA There was at least one LMA note, There were no ETT notes.
General - Inhaled Anesthetic Only There were inhaled anesthetics associated with this case. There were no ETT or LMA notes.
General - Neuromuscular Blocker
Only
There were neuromuscular blockers associated with this case. There were no ETT or LMA notes.
General - Unknown There were both neuromuscular blockers and inhaled anesthetics associated with this case along
with ambiguous general airway notes
Postoperative Hypothermia (TEMP-03)
Measure Description: Percentage of general and/or neuraxial cases with at least one body
temperature ≤ 36
o
C within 30 minutes immediately before or 15 minutes after Anesthesia End.
Success: At least one body temperature measurement ≥ 36
o
C (96.8
o
F) achieved 30 minutes before or
the 15 minutes after Anesthesia End time.
Should the temperature threshold for neonates and infants be changed to 36.5
o
C?
● WHO Definition for neonates (age < 1mo) is 36.5
● 2015 guideline of care for prevention of perioperative hypothermia targets 36.5
○ Evidence IIb: normal core temp age < 5yr is 36.5 to 38.0.
● STEPP-IN (Safe Transitions & Euthermia in the Perioperative Period in Infants & Neonates - wide
multicenter QI effort) used 36.0
Option 1
Keep TEMP-03 with threshold of 36
o
C, Add age group filter to the MPOG QI Dashboard
Preterm Neonate The period at birth when a newborn is born before the full gestational period
Term-Neonate 0 - 27 days (0 - 3 weeks)
Infant 28 days to 12 months (4 - 48 weeks)
Toddler 13 months - 23 months
Child (early) 2 to 5 years
Child (middle) 6 to 11 years
Adolescent (early) 12 to 18 years
Adolescent (late) 19 to 21 years
Option 2
Build a New Measure: TEMP-08-peds
Description: Percentage of patients < 1 month old with at least one body temperature ≤ 36.5
o
C within 30
minutes immediately before or 15 minutes after Anesthesia End.
Success: At least one body temperature measurement ≥ 36
o
C (96.8
o
F) achieved 30 minutes before or the 15
minutes after Anesthesia End time.
Exclusions:
● Patients ≥ 1 month old
● ASA 5 & 6
● Cases with a Anesthesia Start-End duration < 60 min?
● MAC cases?
● Procedure Types
○ All Cardiac (EP/TEE, Cath Lab, open cardiac)
○ Emergent cases
● Cases with Intentional hypothermia
Responsible Provider: Provider present for longest duration of the case per staff role
Performance Threshold: ≤ 20%
Formation of MPOG Peds Interest Groups
• Member driven component of the MPOG peds subcommittee
• Fostering collaboration among pediatric anesthesiologists and
sparking ideas of how MPOG data can be useful in projects of
interest
• Goal to feature 1-2 projects per meeting
• Introduced a Pediatric Mortality project during our last
subcommittee meeting
*MPOG Mortality Workgroup
Members of this workgroup will
1. Receive a monthly report of mortality cases (cardiac and/or
non-cardiac) from your institution to review
2. Perform standardized review of cases ( < 5/month on average)
3. Meet quarterly to discuss findings with other MPOG pediatric
reviewers and identify trends
If interested in joining contact Meridith (meridith@med.umich.edu)
*Limited to MPOG Participating sites
Survey Results
MPOG Peds 2022 Planning
20 Survey Responses. Thank you!!
‘Other’ proposed
within survey
Highest QI Interest/Focus Areas
(5) - Neuromuscular Blockade
Assessment / Reversal / Residual Blockade
(5) - Normothermia
(4) - Cardiac Specific
ERAS / Early Extubation / FEIBA / NIRS Monitoring
(4) - Postoperative Nausea and Vomiting
Opportunity for measure build
Medium QI Interest/Focus Areas
(3) - Glycemic Management
(3) - Infection Control
(3) - Medication Safety
(2) - Pain Management / Regional Anesthesia
(2) - Blood Management
Antibiotic Timing Measure
Proposed
Other Reported QI Interests
• Cardiac Arrest
• Operational Efficiency
– PACU Length of Stay
– Decreased Case Cancellations
– Throughput
• *Minimizing Colloid Use
• NPO Compliance
• *Sustainability
• Clinical Deterioration
• Liver Transplant
• *Low MAP
• EEG Monitoring
*MPOG measure exists
For Congenital Cardiac Anesthesiology patients, there is consideration of facilitating
STS-CCAS data entry using MPOG data. Is this something of interest to you?
Discussion
Which Pediatric QI measures should MPOG work
towards building this year?
Minimizing Colloid Use in Pediatrics (FLUID-02-peds)
Adult colloid measure
currently exists (FLUID-01)
Is there interest in building a
pediatric specific measure?
Next Meeting
Unblinded Pediatric Data Review
Unblinded Pediatric Data Review
• We will begin sharing unblinded data at our next pediatric subcommittee
meeting on May 18th, 2022
• Site QI Champions will be notified that unblinded data will be shared
– They will have the opportunity to opt out
• All participants will be required to sign a confidentiality agreement prior to
the meeting
– A separate registration for this meeting will be required
• Only active MPOG sites will be able to participate and view the data
• We encourage low/high performers on the pediatric measures to speak to
the care they provide and current barriers they face
– Facilitates further discussion and provides additional context to the comparison
scores on the dashboard
Active MPOG Pediatric Sites
Thank You!
