MPOG QI - Quality Committee Meeting Notes – Monday, May 19

, 2025

Attendance:

Abess, Alex (Dartmouth)

LaGorio, John (Trinity Health)

Addo, Henrietta (MPOG)

Lalonde, Heather (Trinity Health)

Agerson, Ashley (Spectrum)

Liwo, Amandiy (UAB)

Balfanz, Greg (North Carolina)

Lewandowski, Kristyn (Corewell)

Battat, Anna (UPenn)

Lopacki, Kayla (Mercy Health - Muskegon)

Bauza, Diego (Weill Cornell)

Lou, Sunny (WUSTL)

Berndt, Brad (Bronson)

Lu-Boettcher, Eva (Wisconsin)

Bollini, Mara (WUSTL)

Malenfant, Tiffany (MPOG)

Bowman-Young, Cathlin (ASA)

McKinney, Mary (Corewell Dearborn / Taylor)

Brennan, Alison (Maryland)

Milliken, Christopher (Sparrow)

Buehler, Kate (MPOG)

Mirizzi, Kam (MPOG)

Cain, James (University of Florida)

Nurani, Shafeena (Corewell Troy)

Calabio, Mei (MPOG)

O’Conor, Katie (Johns Hopkins)

Chiao, Sunny (Virginia)

O’Dell, Diana (MPOG)

Chopra, Ketan (Henry Ford - Detroit)

Ohlendorf, Brian (Duke)

Clark, David (Stanford)

Owens, Wendy (MyMichigan - Midland)

Cohen, Bryan (Henry Ford - West Bloomfield)

Pardo, Nichole (Corewell)

Coleman, Rob (MPOG)

Paul, Jonathan (Columbia)

Colquhoun, Douglas (MPOG)

Pennington, Bethany (WUSTL)

Corpus, Charity (Corewell Royal Oak)

Pimentel, Marc Phillip (B&W)

Cuff, Germaine (NYU)

Poindexter, Amy (Holland)

Delhey, Leanna (MPOG)

Qazi, Aisha (Corewell)

Denchev, Krassimir (St Joseph Oakland)

Ring, Laurence (Columbia)

Dewhirst, Bill (Dartmouth)

Rolfzen, Megan (Nebraska)

Doney, Allison (MGH)

Saffary, Roya (Stanford)

Drennan, Emily (Utah)

Sakkab, Julie (AUB)

Edelman, Tony (MPOG)

Schwerin, Denise (Bronson)

Esmail, Tariq (Toronto)

Scranton, Kathy (Trinity Health St. Mary’s)

Everett, Lucy (MGH)

Shah, Nirav (MPOG)

Gibbons, Miranda (Maryland)

Smiatacz, Frances Guida (MPOG)

Goatley, Jackie (Michigan)

Smith, Mason (MyMichigan)

Goldblatt, Josh (Henry Ford Allegiance)

Stam, Benjamin (UMHS West)

Grewal, Ashan (Maryland)

Stanislaus, Mellany (Johns Hopkins)

Guruswamy, Jayakar (Henry Ford Jackson)

Steadman, Randolph (Houston Methodist)

Hagerman, Sara (Sparrow)

Stewart, Alvin (UAMS)

Hall, Meredith (Bronson Battle Creek)

Stierer, Tracey (Johns Hopkins)

Heiter, Jerri (St. Joseph A2)

Stumpf, Rachel (MPOG)

Henson, Patrick (Vanderbilt)

Toonstra, Rachel (Spectrum Health)

Horton, Brandy (Anes Associates)

Tyler, Pam (Corewell Farmington Hills)

Jacobson, Cameron (Utah)

Uzarski, Michelle (Corewell)

Jared, Jeremy (MPOG)

Vaughn, Shelley (MPOG)

Johnson, Rebecca (Spectrum & UMHS West)

Wade, Meredith (MPOG)

Kaper, Jon (Corewell Trenton)

Wedeven, Chris (Holland)

Khan, Meraj (Henry Ford)

Weinberg, Aaron (Weill Cornell)

Kheterpal, Sachin (MPOG)

Wilson, Blake (MyMichigan)

Kinney, Tyler (Houston Methodist)

Woody, Nathan (UNC)

Kirke, Sarah (Nebraska)

Yuan, Yuan (MPOG)

Kumar, Vikram (MGH)

Zittleman, Andrew (MPOG)

Lacca, Tory (MPOG)

Agenda & Notes

Meeting Start: 1002

1. Agenda

2. Roll Call: Via Zoom or contact Coordinating Center (support@mpog.zendesk.com) if you were

present but not listed on Zoom.

3. Minutes from February 2025 Quality Committee Meeting

4. Featured Members

1. March and April 2025: Tariq Esmail, BMSc, MB Bch BAO, FRCPC, MSc & Justina

Bartoszko, MD, MSc, FRCPC – University Health Network - Toronto

2. May and June 2025: Brandon Togioka, MD – Oregon Health Science University

5. Upcoming Events – 2025 Meetings

1. Friday, July 18, 2025 – ASPIRE Collaborative Meeting – Henry Execute Center – Lansing,

2. Friday, September 2025 – ACQR Retreat – Location TBD

3. Friday, October 10, 2025 – MPOG Retreat – San Antonio, Texas

6. Sustainability Measure Review

1. All MPOG Sustainability measures reviewed by the Sustainability Workgroup

2. April 28, 2025 Meeting Minutes

3. May 12, 2025 Meeting Minutes

Name

Institution

Brady Still, MD

UChicago

Seema Gandhi, MD

UCSF

Ben Stam, MD

Corewell West and UM West

Eva Lu Boettcher, MD

University of Wisconsin

Katie O’Connor, MD, MBA

Johns Hopkins

Nick Dalesio, MD

Johns Hopkins

Lucy Everett, MD

Mass General

Liz Hansen, MD

Seattle Children’s

Jonathan Paul, D.O

Columbia University

Anjan Saha, MD, PhD

Columbia University

Jodi Sherman, MD

Yale

4. SUS-01 – Ben Stam, MD, Corewell West & UM West

a. SUS-01: Fresh Gas Flow, less than or equal to 3 L/min

b. No recommendations for changes to inclusion criteria.

c. Recommended updates to exclusions:

i. Exclude ASA 5 and 6 cases.

ii. Remove exclusion for cases <=30 minutes

d. Dr. Stam recommends retiring SUS-01 as 3L/min is too high to reduce overall

carbon emissions. Would recommend adding another low flow measure for

1L.min and maintaining the SUS-04 2L/min measure.

e. Discussion:

i. Xan Abess (Dartmouth): May be worthwhile to keep the SUS-01

measure for a period of time for new sites who are still working on the

gradual adoption of better (vs.) best practices for sustainability.

ii. Patrick Henson (Vanderbilt): Would also be in favor of keeping SUS-01

for a while for those sites still working on it. Are any sites already

targeting 1L/min? Are you able to do it without 100% FiO2?

1. Ben Stam (Corewell West/UM West): My practice is to target

0.5L/min – can set FiO2 at ~75%. With a 6L circuit wash-in, I can

maintain inspiratory O2~30-40%.

2. Ketan Chopra (Henry Ford Allegiance): Yes – we are working on

1L/min at Henry Ford now.

iii. Ashan Grewal (Maryland): Agree with removing SUS-01 and focusing on

2L/min instead.

iv. Marc Pimentel (BWH): Agree with moving the bar to 2L/min.

v. Ashan Grewal (Maryland): Prefer to exclude cases under 30 minutes

since in such a short case it will likely be difficult to average less than

3L/min when emergence @ MV flow rate might take 5 minutes.

1. Ben Stam (Corewell West/UM West): Remember, when

inspiratory sevo is less than 0.3, those minutes are already

excluded.

f. Vote:

g. Next Steps:

i. Coordinating Center to confirm there was one vote/site as results were

very close.

ii. We will modify SUS-01 to exclude ASA 5 & 6 cases. After tallying votes,

we will maintain the 30-minute exclusion from the measure.

5. SUS-04 – Ben Stam, MD, Corewell West & UM West

a. SUS-04: Fresh Gas Flow, less than or equal to 2 L/min

b. Recommendation to develop new measure to assess low fresh gas flow 1L/min.

c. Recommendation to modify exclusions:

i. Exclude ASA 5 and 6 cases.

ii. Remove exclusion for cases <=30 minutes

d. Vote:

e. Next Steps:

i. Coordinating Center to confirm there was one vote/site as results were

very close.

ii. We will modify SUS-04 to exclude ASA 5 & 6 cases. After tallying votes,

we will maintain the 30-minute exclusion from the measure.

iii. Create a new measure to assess very low gas flow 1L/min. Can

anticipate this new measure to be published within 3-6 months.

6. SUS-02 – Eva Lu-Boettcher, University of Wisconsin

a. SUS-02: Global Warming Footprint, Maintenance

b. Recommend updating calculation to use GWP20 vs. GWP100 for inhaled agents.

Would also recommend creating a new measure that aligns with SUS-02 but

uses the Cuveele method to calculate carbon footprint as it is more accurate but

allows sites to transition to this method over time.

c. Discussion:

i. Blake Wilson (MyMichigan): Would a change to GWP20 underestimate

N2O environmental impact?

1. Nirav Shah (MPOG Coordinating Center): I think GWP20 and

GWP100 for nitrous are the same, in the sources we used.

ii. Douglas Colquhoun (MPOG Associate Research Director): Digging into

this, we’re likely underestimating carbon footprint by about 16% with

the current SUS-02 calculation. By converting to the Cuveele method,

we would likely be underestimating by about 7%.

d. Vote:

e. Next Steps:

i. Modify SUS-02 to use GWP20 values for inhaled agents – will assess

Michigan site scores independently to determine when measure change

will be released as this is a P4P and VBR measure.

ii. Develop new measure that calculates carbon footprint using the

Cuveele Method.

7. SUS-03 – Eva Lu-Boettcher, University of Wisconsin

a. SUS-03: Global Warming Footprint, Induction

b. Recommends updating calculation to use GWP20 vs. GWP100 for inhaled

agents.

c. Also recommends increasing the upper limit threshold to 250kg to ensure no

cases would be flagged (currently at 50kg).

d. Recommends building a new measure to assess fresh gas flow during induction

with an upper limit around 6L/min.

e. Vote:

f. Next Steps:

i. Update upper threshold for SUS-03 to 250kg to ensure cases aren’t

flagged for this informational measure.

ii. Modify SUS-03 to use GWP20 values for inhaled agents

iii. Create new measure to assess FGF during induction with a threshold of

6L/min.

8. SUS-07 – Nirav Shah, MPOG Coordinating Center

a. Tabled for next meeting.

Meeting Adjourned: 1102

Next meeting: Monday, July 28, 2025