Quality Committee
Meeting
January 23, 2023
10:00am - 11:00am Eastern Time
Meeting Minutes
November 2022
Roll Call – via Zoom or
contact us
Announcements
Congrats to
Columbia
University Irving
Medical Center
for completing
their recent
Import Manager
conversion!
Chair: Ansgar Brambrink, MD, PhD
Principal Investigator: Mitch Berman, MD
Congrats to
University of
Pennsylvania
Medical Center
for completing
the Import
Manager
conversion!
Chair: Deborah Culley, MD
Quality Champion: Scott Falk, MD
Principal Investigator: Thomas Joseph, MD
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
2023-2024 Outcomes Research Fellowship
● Opportunity to complete a one-year fellowship either onsite at the MPOG coordinating center
(University of Michigan, Ann Arbor, MI) or as a hybrid experience at MPOG participating site
● A minimum of 50% non-clinical time devoted to MPOG fellowship activities
● Fellows will engage in a Practicum Capstone Project related to an MPOG-based clinical research
project or quality measure
● Application packet (cover letter, current CV, letters of support, 1-page research plan and 1-page
training plan) due by February 10, 2023
● More information and FAQs available at https://mpog.org/research-fellowship/
QI Measure Page Updated!
Still to come…
- Add flowcharts to outline measure logic
- Improve mobile UI
- Add ability to attach supporting documents
OPIOID : Opioid Equivalency
Rationale:
There remains variation in perioperative analgesia techniques.
Understanding opioid administration to help improve perioperative care.
Oral morphine equivalency (OME) is often used to compare opioid consumption.
We created this algorithm based on conversions obtained from literature.
Significant effort to develop algorithms to ensure proper capture.
This measure is intended as an informational tool to help understand opioid use in the operating room.
Details:
Cases are grouped by surgical site using CPT groupings.
Opioid equivalents are calculated using conversions derived from literature and given between anesthesia start and anesthesia end.
OME is normalized to patient weight (kg) and duration of anesthetic (anesthesia end – anesthesia start, hours as a decimal).
This is a process (informational) measure; success is not defined for these measures - informational only.
There is no threshold to achieve.
The measure time period is Anesthesia Start to Anesthesia End.
The measure returns a single value per case.
Measure Review:
https://docs.google.com/document/d/1pGJSVI-4hV1la5aM55OV1IJcwwZ2oIgF474ajQqXVUo/edit#heading=h.59kcj478p51l
Public Spec:
https://spec.mpog.org/Spec/Public/37
OPIOID : Opioid Equivalency
ASPIRE OME
The following case categories are currently included:
- Cardiac
- Spine (Adult): Patients ≥ 18yo
- Spine (Pediatric): Patients < 18yo
- Upper Abdomen
- Lower Abdomen
- Hysterectomy
- Knee/Popliteal
- Hip
- Tonsil/Adenoid (Pediatrics): Patients < 18yo
Review of Literature - OME
Reviewed the references within the measure specifications
Looked at articles that have references these articles over the past 10 years.
There were no major changes in conversions form the literature.
Reviewed new literature over the past 10 years for additional conversions
There were no major changes in conversions form the literature.
https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf
CDC clinical practice guideline for prescribing opioids for pain US, 2022
https://stacks.cdc.gov/view/cdc/122248
Review of Literature - OME
Reviewed EPIC’s OME conversions in comparison
to those used in our OME measure
Measure OME conversions were close/exact in all instances:
13 medication/route combinations matched.
7 medication/route combinations were in EPIC and not in our measure:
Belladonna (rectal)
Dihydrocodeine (oral)
Meperidine (IM)
Meperidine (SQ)
Meperidine (IV)
Opium (oral)
Pentazocine (oral)
21 medication/route combinations were in our measure but NOT in EPIC.
Recommendations - OME
Rationale is still mostly appropriate.
Unsure how often this is used as part of QI efforts around MPOG.
Feedback from group: is the OME measure useful?
1. Consider adding another procedure group: Vascular
Feedback from group: Should we add other case categories?
2. Consider adding in a few medications for which there are identified conversions:
● Belladonna (rectal)
● Dihydrocodeine (oral)
● Meperidine (IM)
● Meperidine (SQ)
● Meperidine (IV)
● Opium (oral)
● Pentazocine (oral)
Feedback from group: Should we add other medications?
3. Consider including PACU data if available (would be a new measure)
Vascular
00880 Anesthesia for procedures on major lower abdominal vessels;
not otherwise specified
00882 Anesthesia for procedures on major lower abdominal vessels;
inferior vena cava ligation
Opioid Equivalency 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
Measure Updates
TEMP 01
TEMP 01 Update: Exclude cesarean deliveries
Description:
Percentage of cases in which an active warming device was applied intraoperatively, or the patient
maintained a temperature above 36.0°C without active warming.
Active warming defined as:
- Convective warming
- Conductive warming
- Endovascular warming
- Radiant heaters
Exclusions:
- Labor epidurals & cases less than 60 minutes case duration
- Added exclusion for cesarean deliveries per Obstetric Subcommittee vote (12/2022)
*Minimal change to performance scores: Scores increased on average of 1.2%
NMB
Guideline
Update
Implications for MPOG
Aligned with our measures though recommend quantitative over qualitative NMB
monitoring (NMB-01)
Try to understand how often quantitative monitoring is used
Sugammadex recommended for deep, moderate, or shallow levels of NMB
blockade from rocuronium or vecuronium
Analyze usage of sugammadex vs neostigmine
Sustainability
Toolkit
Sustainability Toolkit coming soon!
Thank you to Armaan Patel for reviewing
the literature to create this toolkit!
Includes presentation slides: modify as
needed to share with your departments
Please let us know if you wish to see a
early version to review and provide
feedback
Will be posted to the MPOG website by end
of February
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?
