Cardiac Anesthesia Subcommittee Minutes

Dec 8, 2023

1:00pm – 2:00pm EST

Zoom

- Unblinded Data Review Session – Registration Required

Addo, Henrietta (MPOG)

Kertai, Miklos (Vanderbilt)

Atwood, Tammy (Henry Ford)

Kinney, Daniel (Yale)

Barrios, Nicole (MPOG)

Malenfent, Tiffany (MPOG)

Benitez Lopez, Julio (MyMichigan)

Mathis, Mike (MPOG)

Billings, Josh (Vanderbilt)

Meuhlshlegel, J. Danny (Johns Hopkins)

Brown, Morgan (Boston Children's)

Notarrianni, Andrew (Yale)

Buehler, Kate

(MPOG)

Schonberger, Robert (Yale)

Fisher, Clark (Yale)

Smiatacz, Frances Guida (MPOG)

Geube, Mariya (Cleveland)

Sturmer, David (Michigan)

Grewal, Ashan (Maryland)

Theurer, Patty (Michigan)

Heiter, Jerri (Trinity)

Wade, Meridith (MPOG)

Janda, Allison (MPOG)

Zittleman, Andrew (MPOG)

1303

Meeting Summary

1. Discussion of Proposed Antibiotic Measures

a. ABX-02: Antibiotic Timing for Open Cardiac Procedures

i. Description: Percentage of adult patients undergoing open cardiac surgery with

antibiotic administration initiated within the appropriate time frame before surgical

incision.

ii. Timing: 120 minutes prior to Surgery Start Time through Surgery Start Time

iii. Attribution: All anesthesia providers signed in at the time of Surgery Start Time

*For cases without a documented surgical incision time or procedure start time, the case will be

flagged for review.

iv. Inclusions: All patients, 18 years of age or older, who undergo open cardiac surgical

procedures (as determined by Procedure Type: Cardiac phenotype: value = 1) under

general anesthesia with duration of anesthesia lasting ≥ 120 minutes

v. Exclusions:

1. ASA 6 or Organ harvest (CPT: 01990)

2. Non-cardiac cases as defined as those cases not meeting criteria for the

cardiac case type phenotype

3. Within the general cardiac case type phenotype, exclude:

Transcatheter/Endovascular, EP/Cath groups and Other Cardiac

4. Patient age <18

5. Patients already on scheduled antibiotics or had a documented infection

prior to surgery, as specified by “Patient on Scheduled

Antibiotics/Documented Infection” (value: 2) of the ABX Notes Phenotype

vi. Included Antibiotics:

vii. See presentation for preliminary performance ABX-02 data.

viii. DISCUSSION:

1. Exclude Lung Transplants across all cardiac measures?

a. Josh Billings (Vanderbilt University): Lung transplants should not be

lumped with cardiac cohort.

b. Miklos Kertai (Vanderbilt University): Totally agree – should be

excluded from this measure, not included in cardiac cohort.

c. Ashan Grewal (University of Maryland) via chat: Is there any specific

reason to exclude except that at some institutions they are

performed by non-cardiac surgeons and cared for by non CT

Anesthesiologists?

d. Mike Mathis (MPOG Research Director, UMichigan): I lean towards

Antibiotic

Appropriate Start Time

Antibiotic

Appropriate Start Time

Azithromycin

Within 90 minutes before incision

Ceftriaxone

Within 60 minutes before

incision

Cefamandole

Within 60 minutes before incision

Cefuroxime

Within 60 minutes before

incision

Cefazolin

Within 60 minutes before incision

Ciprofloxacin

Within 90 minutes before

incision

Cefepime

Within 60 minutes before incision

Daptomycin

Within 120 minutes before

incision

Cefotaxime

Within 60 minutes before incision

Gentamicin

Within 90 minutes before

incision

Cefotetan

Within 60 minutes before incision

Levofloxacin

Within 90 minutes before

incision

Cefoxitin

Within 60 minutes before incision

Vancomycin

Within 120 minutes before

incision

Ceftazidime

Within 60 minutes before incision

Ceftriaxone

Within 60 minutes before

incision

Ceftizoxime

Within 60 minutes before incision

Cefuroxime

Within 60 minutes before

incision

not having the lung transplants included.

e. Allison Janda ((MPOG Cardiac Subcommittee Chair): Sounds great,

we will move to exclude lung transplants from this measure.

2. If more than one antibiotics are given, do they all need to be on time or just

one?

a. Allison Janda (MPOG Cardiac Subcommittee Chair): Our measure

includes all cephalosporins based on the 2018 European guidelines

i. Links to the guidelines:

1. https://www.guidelinecentral.com/guideline/198

52/

2. https://pubmed.ncbi.nlm.nih.gov/37075942/

3. STS Guideline:

https://www.sts.org/sites/default/files/document

s/Clinical%20Guidelines/AntibioticProphylaxisCard

iacSurgeryPart_IIAntibiotic_Choice.pdf

b. Josh Billings (Vanderbilt University): Do the guidelines say whether

we should stick to one antibiotic before incision.

c. Allison Janda (MPOG Cardiac Subcommittee Chair): For cardiac

cases based on the Bardia and Schonberger articles it was any

antibiotics should be given within the appropriate window.

d. Rob Schonberger (Yale): I think that’s correct. And then whether the

antibiotic was appropriately redosed.

e. Clark Fisher (Yale): Lack of variation is not a reason to not have it a

part of the measure, at least for people reviewing their own cases.

It’s interesting that the one site with a 20% success rate and curious

if this is a data quality issue. In my experience procedure start and

stop may not be correct.

f. Allison Janda (MPOG Cardiac Subcommittee Chair): We still have

some additional validation to do but wanted to bring it to this group

to get some initial feedback. We are excluding topical abx like

irrigation so that outlier site could be documenting antibiotics as

topical instead of intravenous.

3. Vote to move forward with measure development?

a. Despite a lack of variation it sounds like cases are still worth

reviewing for individual practice.

4. Next Steps:

a. Exclude lung transplants for all ABX cardiac measures

b. Move forward with releasing ABX-02

b. ABX-03: Antibiotic Re-dosing for Open Cardiac Procedures

i. Description: Percentage of adult patients undergoing open cardiac surgery with an

antibiotic re-dose initiated within four hours after initial antibiotic administration

(cephalosporins only).

ii. Success: Re-dosed within 180-240 minutes after each cephalosporin administration.

(For longer cases, a second re-dose within 180-240 minutes after initial re-dose is

required unless there is ≤ 240 minutes between a cephalosporin dose and

anesthesia end.)

iii. Attribution: Provider(s) signed in at the time of each re-dose (If not given: 240

minutes after initial cephalosporin dose, and/or if not given: 240 minutes after the

first re-dose)

iv. Inclusions:

1. Adult patients undergoing open cardiac surgical procedures

2. Patients receiving initial antibiotic prophylaxis with a cephalosporin

v. Exclusions:

1. ASA 6 or Organ harvest (CPT: 01990)

2. Patient age <18

3. Cases where Anesthesia End time occurs before redose is due (4 hours after

cephalosporin dose)

4. Cases without a cephalosporin for initial dose of antibiotic prophylaxis

5. Non-cardiac, Transcatheter/Endovascular, EP/Cath, and Other Cardiac cases

(determined by the Procedure Type: Cardiac value codes: 0, 2, 3, and 4)

6. Patients already on scheduled antibiotics or had a documented infection

prior to surgery, as specified by “Patient on Scheduled

Antibiotics/Documented Infection” (value: 2) of the ABX Notes Phenotype

vi. Cases will be assigned one of the following result reasons:

1. Passed - Re-dose(s) administered on time

2. Flagged - Non-standard antibiotic selection

3. Flagged - Incision/procedure start time documented: No

4. Flagged - Antibiotic re-dose too late

5. Flagged - Antibiotic re-dose too early

6. Excluded - Scheduled antibiotics/documented infection

7. Excluded - No initial cephalosporin dose

8. Excluded - Re-dose not required

9. Excluded - ASA 6

10. Excluded - Non-Cardiac

11. Excluded - Age<18

vii. See presentation for preliminary performance ABX-03 data.

viii. DISCUSSION:

1. Allison Janda (MPOG Cardiac Subcommittee Chair): This measure could

allow for more than one flag per provider or attributing multiple providers

depending on how many re-doses were indicated.

2. Danny Meuhlshlegel (Johns Hopkins): How do we define a re-dose? Bolus

only or does an infusion count?

3. Allison Janda (MPOG Cardiac Subcommittee Chair): Both count for this

measure, but we did have a question for the group regarding infusions.

a. Danny Meuhlshlegel (Johns Hopkins): What about infusing for

duration of the case?

b. Allison Janda (MPOG Cardiac Subcommittee Chair): Some sites do

have very long infusions documented. If you run them as

continuous infusions, do we think the data is accurately captured or

is this a documentation issue?

c. Danny Meuhlshlegel (Johns Hopkins): We bolus the 2 gm initially

and then infuse 1g/hr dependent for however long the case is

d. Allison Janda (MPOG Cardiac Subcommittee Chair): We did see that

in some of our prelim validation. What does the group think about

treating this as a success for the measure?

e. Kate Buehler (MPOG Clinical Program Manager): There is another

large academic center that does this also. They are not represented

on the call but I will reach out to see if this is standard practice or

not.

f. Rob Schonberger (Yale): I agree with Danny. If an infusion runs for

the duration of the case, it should pass.

g. Clark Fisher (Yale): Agree. This measure is assessing underdosing so I

think overdosing should still count as compliant.

h. Danny Meuhlshlegel (Johns Hopkins): I don’t know how this infusion

practice was instituted but am looking into at why our site practices

this way

4. Clark Fisher (Yale): Anesthesia end is currently the measure end. I wonder if

this should be updated to surgery end since it can be a while between

surgery end and anesthesia end. If the case is over, no need to redose after

surgery end.

a. Allison Janda (MPOG Cardiac Subcommittee Chair): We could use

procedure end and if not available use anesthesia end.

5. Allison Janda (MPOG Cardiac Subcommittee Chair): Preliminary

performance shows a lot more variability since there are a lot more

opportunities for flags.

6. Morgan Brown (Boston Children’s via chat): We do not do an infusion, but

we have a separate protocol for redosing which is not compliant with the

STS guidelines.

a. Mike Mathis (MPOG Research Director, UMichigan via chat):

Morgan - do you have a succinct detailing of BCH protocol? (And I

assume peds cases since BCH?)

i. Morgan Brown (Boston Children’s via chat): CPB cases who

receive cefazolin receive additional cefazolin in the CPB

circuit and then a dose when off CPB. It is independent of

timing. Gets more complicated if its not cefazolin.

ii. Mike Mathis (MPOG Research Director, UMichigan): Is that

kefzol given in the circuit charted in the EMR or in perfusion

documentation?

iii. Morgan Brown (Boston Children’s) - Documented by

perfusion but feeds into the chart.

iv. Allison Janda (MPOG Cardiac Subcommittee Chair) - What

about non cardiac bypass cases? When do those get

redosed?

v. Morgan Brown (Boston Children’s): I don’t think we’re

meeting the guidelines on that – our protocols say every

four hours but I don’t think we’re currently meeting that.

vi. Kate Buehler (MPOG Clinical Program Manager): Peds case

are currently excluded from these measures. Maybe this is a

topic we should bring back to the peds cardiac workgroup –

are there guidelines to support a measure for peds cardiac

cases?

vii. Morgan Brown (Boston Children’s): There is less literature to

support a measure for peds-specifically but we do a lot of

>18 cases as well so it would also pertain to them.

7. Do we need a separate measure for other antibiotic redosing? Gets tricky

with renal dysfunction. What does the group think about sticking to

cephalosporins?

a. Allison Janda (MPOG Cardiac Subcommittee Chair): I’ll take silence

as confirmation that we should stick with cephalosporins for now.

b. Rob Schonberger (Yale): Agree

8. Next Steps:

a. Proceed with build

b. Exclude lung transplant cases

c. Infusions running for the duration of the case will pass

d. Update measure end time to: Surgery end, if not available, use

anesthesia end.

c. ABX-04: Antibiotic Selection for Open Cardiac Procedures

i. Description: Percentage of adult patients undergoing open cardiac surgery with an

appropriate antibiotic administered for surgical site infection prophylaxis.

ii. Timing: 120 minutes prior to Anesthesia Start through Anesthesia End

iii. Attribution: All anesthesia providers signed in at the time of Anesthesia Start

iv. Inclusions: Adult patients undergoing open cardiac surgical procedures

v. Exclusions:

1. ASA 6 or Organ harvest (CPT: 01990)

2. Patient age <18

3. Non-cardiac cases as defined as those cases not meeting criteria for the

cardiac case type phenotype

4. Within the general cardiac case type phenotype, exclude:

Transcatheter/Endovascular, EP/Cath groups and Other Cardiac

5. Patients already on scheduled antibiotics or had a documented infection

prior to surgery, as specified by “Patient on Scheduled

Antibiotics/Documented Infection” (value: 2) of the ABX Notes Phenotype

vi. Acceptable Antibiotics:

1. Vancomycin (or Daptomycin) + Cephalosporin

2. Vancomycin (or Daptomycin) + Aminoglycoside

3. Cephalosporin Only

vii. Cases will be assigned one of the following result reasons:

1. Passed - Appropriate Antibiotics Administered

2. Flagged - Non-standard antibiotic selection

3. Flagged - Prophylactic antibiotic administered (Not documented in MAR)

4. Flagged - Antibiotic not ordered/indicated per surgeon

5. Flagged - Incision/procedure start time documented: No

6. Flagged - Not administered for medical reasons

7. Excluded - Scheduled antibiotics/documented infection

viii. DISCUSSION:

1. Is the list of antibiotics acceptable? Should we add macrolides and

fluroquinolones? Do other sites have those in their guidelines?

a. Allison Janda (MPOG Cardiac Subcommittee Chair): Planning to have

a pharmacist review this measure and provide input on this as well.

Should we defer to the pharmacist experts on antibiotics to include?

b. Danny Meuhlshlegel (Johns Hopkins): Agree, get pharmacy input

c. Mike Mathis (MPOG Research Director, UMichigan): Is there an

additional consideration if patient has an allergy to vancomycin?

d. Allison Janda (MPOG Cardiac Subcommittee Chair): We've included

other antibiotics that could be used instead of vancomycin as well,

but the case would still pass as long as a cephalosporin is given.

e. Kate Buehler (MPOG Clinical Program Manager): Is the group

supportive of a selection measure as an anesthesia group since

surgeons are typically responsible for antibiotic selection? This has

been a concern for other MPOG Subcommittees – would like to

address before we move forward with building this measure.

i. Rob Schonberger (Yale): No hesitancy but am open to others

having them.

ii. Mike Mathis (MPOG Research Director, UMichigan): In the

past, our MPOG QI philosophy has been that even if the

individual anesthesiologist is not ‘solely responsible’ for the

flagged case, they can still be the agent for change. They are

part of a larger multidisciplinary team and important to

review at an individual case level.

iii. Kate Buehler (MPOG Clinical Program Manager): Sounds

good. We will proceed with build!

ix. Next Steps:

1. Proceed with measure build.

2. Consult pharmacist regarding antibiotics to include

d. ABX-05: Composite Antibiotic Compliance for Open Cardiac Procedures

i. Description: Percentage of adult patients undergoing open cardiac surgery

appropriate antibiotic selection, timing, and re-dosing administered for surgical site

infection prophylaxis.

ii. Timing: 120 minutes prior to Anesthesia Start through Anesthesia End

iii. Attribution: Departmental Only – Not available for Provider Feedback Emails

iv. Success: Case is passed for all open cardiac antibiotic measures (timing, re-dosing,

selection)

v. Inclusions: Adult patients undergoing open cardiac surgical procedures

vi. Exclusions:

1. ASA 6 or Organ harvest (CPT: 01990)

2. Patient age <18

3. Non-cardiac cases as defined as those cases not meeting criteria for the

cardiac case type phenotype

4. Within the general cardiac case type phenotype, exclude:

Transcatheter/Endovascular, EP/Cath groups and Other Cardiac

5. Patients already on scheduled antibiotics or had a documented infection

prior to surgery, as specified by “Patient on Scheduled

Antibiotics/Documented Infection” (value: 2) of the ABX Notes Phenotype

vii. DISCUSSION:

1. Is the attribution at the departmental level acceptable?

a. Allison Janda (MPOG Cardiac Subcommittee Chair): Although we

aren’t directly in control of the antibiotic orders for each case, with

this composite measure, we could bring back data at the systems

level to say we aren’t in compliance with the guidelines. Again, we

wouldn’t be giving individual clinicians feedback for this measure.

2. Danny Meuhlshlegel (Johns Hopkins): Sounds reasonable.

3. Allison Janda (MPOG Cardiac Subcommittee Chair): Sounds good. We will

proceed with measure build.

viii. Next Steps:

1. Proceed with measure build

2. No provider attribution – departmental only measure

2. Unblinded Data Review Session – Glycemic Management Measures

a. Closed review session – open only to those who registered and signed the confidentiality

attestation

b. Site Participation:

i. All sites that perform >75 open cardiac procedures annually are presented on the

slides

ii. Only those sites who have a participant on the cardiac subcommittee are unblinded

iii. Cardiac Anesthesia Champions were notified that unblinded data would be shared

and were given the opportunity to opt out

iv. No sites emailed us to express a desire to be excluded from this review

c. GLU-06: Hyperglycemia avoidance measure

- available on cardiac dashboards!

i. Description: Percentage of patients, ≥18 years age, who undergo open cardiac

surgical procedures under general anesthesia of 120 minutes case duration or

longer for whom any blood glucose measure did not exceed 180 mg/dL (and not

rechecked within 30-minutes and found to be </=180 mg/dL) was documented.

ii. Note: open cardiac cases without ANY glucose values documented are flagged

iii. Unblinded site data shared – removed from slides posted to the website for

confidentiality reasons.

iv. Flagged Case Analysis (see slides for data presented):

1. Majority of cases in MPOG flagged due to high glucose value documented;

Only 2% of cases flagged due to no glucose checked

2. Majority of high glucose values found in non-diabetic patients (70%)

3. High glucose value documented while patient was on bypass for the

majority of flagged cases

4. Majority of flagged cases did not have an insulin gtt running at the time of

high glucose value (80%)

v. DISCUSSION:

1. Allison Janda (MPOG Cardiac Subcommittee Chair): Our site has had a big

push to improve our glucose management in cardiac surgery. We instituted

a new protocol and after one month we have had some improvement. We

aren’t quite at our goal performance but definitely a step in the right

direction.

2. Josh Billings (Vanderbilt University): How many glucose labs are submitted

per case per site?

a. Allison Janda (MPOG Cardiac Subcommittee Chair):This is something

we could look into but it looks like a handful. Kate, do you have any

insight?

b. Josh Billings (Vanderbilt University): Based on how they run their

labs, central vs. POC), are there some sites that do a dozen ABGs for

a case. Just curious if there’s any bias in the lab modality.

c. Allison Janda (MPOG Cardiac Subcommittee Chair): Great question.

d. Kate Buehler (MPOG Clinical Program Manager): It is so widely

variable across sites. Some sites don’t submit any glucose during

cardiac cases.

e. Josh Billings (Vanderbilt University): I’m just wondering if there are

reporting issues. The 2% of cases that don’t have glucose, I would

be very surprised that any CPB case wouldn’t have a glucose. Adding

the number of glucose labs to the histogram would be informative.

f. Jerri Heiter (Trinity Health via chat): seeing min. invasive epicard

ablation, left appendage lig. cases without being checked, others

check more compliant

g. Kate Buehler (MPOG Clinical Program Manager): I think there is at

least one site that is not reporting glucose labs or have an issue

sending it over in the MPOG data extract. It is a fair amount of work

for sites to implement data sync between their POC and formal lab

systems. However, most MPOG sites have figured that out and are

sending these labs consistently.

h. Allison Janda (MPOG Cardiac Subcommittee Chair): Josh, I hear what

you are saying that sites with 12 labs have 12 opportunities to flag

vs a site that has less. Good news is these are not VBR measures and

only purpose is to improve care, but overall, we should be checking

glucoses on these patients frequently.

3. Patty Theurer (MSTCVS via chat): Thank you for having us! The statewide

(MI) cardiac surgery collaborative is working on this measure also - and we

recognize we can't possibly make progress without you!

4. Mike Mathis (MPOG Research Director, UMichigan): Cases without a glucose

lab should be flagged.

a. Allison Janda (MPOG Cardiac Subcommittee Chair): Yes, they are

currently flagged.

5. Mariya Geube (Cleveland Clinic): Are these all pump cases or include TAVR,

EP cases and others....? Thank you.

a. Allison Janda (MPOG Cardiac Subcommittee Chair): These are just

open cardiac cases and do not include TAVR, EP cases.

6. Mike Mathis (MPOG Research Director, UMichigan): In regards to timing of

high glucose (on bypass)…this definitely tells the story that the way we tend

to fail our glucose measure is we need to have better coordination with our

perfusion team. I’m optimistic that with our recent efforts at our institution

that we will continue to improve that coordination. It may be helpful for

other sites to focus on this as well.

7. Ashan Grewal (University of Maryland): In regards to high glucose while on

insulin gtt, is this the first glucose being over 180 vs. rechecked high values?

a. Kate Buehler (MPOG Clinical Program Manager): This is the first

high glucose that flagged the case. If you had multiple, we use the

first lab to determine if the insulin drip is running. The next analysis

we should do is to see if you continued to run the infusion after the

initial high glucose that flagged the case.

8. Clark Fisher (Yale): Because we have the opportunity to look at the

unblinded data, I’m curious what all intuitions glucose protocols are, not

just limited to cardiac procedures.

9. Allison Janda (MPOG Cardiac Subcommittee Chair): Good food for thought

as we process the other unblinded measure data to follow…

d. GLU-07: Hypoglycemia avoidance measure

– available on cardiac dashboards!

i. Description: Percentage of adult patients, undergoing open cardiac surgery with any

intraoperative blood glucose value < 70 mg/dL.

ii. Note: open cardiac cases without ANY glucose values documented are flagged

iii. Timing: Anesthesia Start to 15 minutes after Anesthesia End

iv. Inverse Measure: Lower performance is better.

v. Unblinded site data shared – removed from slides posted to the website for

confidentiality reasons.

vi. Flagged Case Analysis (see slides for data presented):

1. More than half of cases (55%) in MPOG flagged due to no glucose value

documented on the case. Much lower denominator of cases that are flagged

in comparison to the GLU-06 (hyperglycemia) measure

2. Majority of flagged cases in diabetics due to actual hypoglycemia (~55%);

majority of flagged cases in non-diabetic patients due to no glucose checked

(60%)

3. Low glucose values documented during pre-bypass time period or while

patient was on bypass for the majority of flagged cases

4. Majority of flagged cases did not have an insulin gtt running at the time of

high glucose value (77%)

e. GLU-08: Hyperglycemia Treatment Measure

– available on cardiac dashboards!

i. Description: Percentage of patients, ≥18 years age, who undergo open cardiac

surgical procedures under general anesthesia of 120 minutes case duration or

longer for whom any blood glucose measure >/=180mg/dL was either treated with

insulin or rechecked and found to be <180mg/dL within 30 minutes.

ii. Note: open cardiac cases without ANY glucose values documented are flagged

iii. Timing: Anesthesia Start to 30 minutes after Anesthesia End

iv. Unblinded site data shared – removed from slides posted to the website for

confidentiality reasons.

v. Flagged Case Analysis (see slides for data presented):

1. Majority of flagged cases (~85%) in MPOG due to high glucose not treated

2. Majority of flagged cases in diabetics due to actual hyperglycemia in both

diabetic and non-diabetic patients. Far more cases with hyperglycemia

reported in non-diabetic patients (5,021) compared to diabetic patients

(1,931)

3. High glucose values primarily documented during bypass for flagged cases

4. Majority of flagged cases did not have an insulin gtt running at the time of

high glucose value (99%)

f. DISCUSSION:

i. See slides for analysis breakdown (blinded)

ii. Follow up: Share glucose protocols across sites for both cardiac and non-cardiac

patients

iii. Mike Mathis (MPOG Research Director, UMichigan): Is there a coordination

between perfusion and anesthesia at other institutions? Is it protocol or just a

communication?

1. Clark Fisher (Yale): We have good communication between cases but there

is no institutional guidance or protocol on how to work together to achieve

this.

2. Ashan Grewal (University of Maryland): We have a glucose protocol but no

protocol with perfusion involvement. We see all the blood gases they run

and react to those but nothing else.

3. Allison Janda (MPOG Cardiac Subcommittee Chair): We used to do that as

well at Michigan until we implemented this new protocol involving

perfusionists.

4. Josh Billings (Vanderbilt University): Perfusion doesn’t give the insulin at our

institution; anesthesia gives all insulin.

5. Mariya Geube (Cleveland Clinic): We do check ABG for glucose every hour if

not more often. For every case, we check 8-10 ABGs. So I wonder if that has

something to do with our performance. We also start the insulin right

around 180, we don’t really start it at 150 but this is another reason why we

could have a high percentage of cases that are above 180. We check ABGs

every 30-60 minutes. The more often you check, the more chances you have

to flag the measure.

6. Allison Janda (MPOG Cardiac Subcommittee Chair): We often have an insulin

infusion running so that would count as ‘treatment’ for GLU-08.

7. Clark Fisher (Yale via chat): From an operations standpoint, I’m very curious

about how many infusions of any type people generally start with. We need

to work pretty hard to get more than 4 infusion pumps to begin.

a. Allison Janda (MPOG Cardiac Subcommittee Chair): That’s an

interesting point. We could ask sites to submit via the forum how

many infusion pumps they typically start the case with.

b. Julio Benitez Lopez (MyMichigan): 8 pumps available to start at our

site

3. Cardiac Anesthesia Subcommittee Membership

a. Next meetings:

i. April 2024

ii. August 2024

iii. Nov/Dec 2024

b. Open to all anesthesiologists or those interested in improving cardiothoracic measures

i. Do not have to practice at an active MPOG institution to participate

c. Thank you for continued use of the Basecamp forum for discussion between meetings!

Meeting adjourned at 1408 EST