MPOG QI - Quality Committee Meeting Notes – Monday, November 24

, 2025

Attendance:

Abess, Alex (Dartmouth)

King, Lisa (Oklahoma)

Wade, Meredith (MPOG)

Bauza, Diego (Weill Cornell)

Kirke, Sarah (Nebraska)

Wedeven, Chris (Holland)

Berndt, Brad (Bronson)

Krauss, Kristin (Temple)

Weinberg, Aaron (Weill Cornell)

Bollini, Mara (WUSTL)

Kumar, Vikram (MGH)

Wildes, Troy (Nebraska)

Brennan, Alison (Maryland)

Kunkler, Bryan (Corewell West)

Yacoubian, Stephanie (B&W)

Brown, Morgan (Boston Children’s)

Lacca, Tory (MPOG)

Zehr, Levi (Nebraska)

Bryant, Ayesha (UAB)

Lalonde, Heather (Trinity Health)

Zhao, Xinyi (Sarah) (MPOG)

Buehler, Kate (MPOG)

Liu, Bin (Michigan Medicine)

Zittleman, Andrew (MPOG)

Cain, James (University of Florida)

Lewandowski, Kristyn (Corewell Troy)

Calabio, Mei (MPOG)

Lopacki, Kayla (Mercy Health -

Muskegon)

Cassidy, Ruth (MPOG)

Mathis, Mike (MPOG)

Charette, Kristin (Dartmouth)

Malenfant, Tiffany (MPOG)

Chopra, Ketan (Henry Ford - Detroit)

McComb, Joseph (Temple U)

Clark, David (MPOG)

McKinney, Mary (Corewell Dearborn

Taylor)

Cohen, Bryan (Henry Ford - West

Bloomfield)

Milliken, Christopher (Sparrow)

Coleman, Rob (MPOG)

Mirizzi, Kam (MPOG)

Colquhoun, Douglas (MPOG)

Musulin, Angela (Henry Ford)

Corpus, Charity (Corewell Royal Oak)

O’Conor, Katie (Johns Hopkins)

Cusick, Jordan (OHSU)

O’Dell, Diana (MPOG)

Delhey, Leanna (MPOG)

Owens, Wendy (MyMichigan - Midland)

Denchev, Krassimir (St Joseph Oakland)

Pace, Nathan (Utah)

Dewhirst, Bill (Dartmouth)

Pantis, Rebecca (MPOG)

Doney, Allison (MGH)

Pardo, Nichole (Corewell Grosse Pointe)

Drennan, Emily (Utah)

Pennington, Bethany (WUSTL)

Dutton, Richard (US Anes Partners)

Phillips, Brad (MD Anderson)

Esmail, Tariq (Toronto)

Pimentel, Marc Phillip (B&W)

Everett, Lucy (MGH)

Poindexter, Amy (Holland)

Finch, Kim (Henry Ford Detroit)

Rolfzen, Megan, MD (Michigan)

Goatley, Jackie (Michigan)

Roselinsky, Howard (Yale)

Goldblatt, Josh (Henry Ford Allegiance)

Sayyid, Sahar (AUB)

Grewal, Ashan (Maryland)

Schwerin, Denise (Bronson)

Hall, Meredith (Bronson Battle Creek)

Scranton, Kathy (Trinity Health St.

Mary’s)

Heiter, Jerri (St. Joseph A2)

Shah, Nirav (MPOG)

Huntington, Michelle (Corewell West))

Shettar, Shashank (OUHSC)

Janda, Allison (MPOG)

Smiatacz, Frances Guida (MPOG)

Jared, Jeremy (MPOG)

Smith, Mason (MyMichigan)

Johnson, Rebecca (UMHS West)

Stewart, Alvin (UAMS)

Kaper, Jon (Corewell Trenton)

Stierer, Tracey (Johns Hopkins)

Karamchandani, Kunal (UT Southwestern)

Tyler, Pam (Corewell Farmington Hills)

Karpalaney, Sakshi (UHN)

Vaughn, Shelley (MPOG)

Agenda & Notes

Opening, Attendance, and Minutes:

• Meeting Start: 1001

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

present but not listed on Zoom.

• Minutes from September 2025 Quality Committee Meeting

Announcements:

Featured Members

• November and December: Megan Anders, MD, MS – University of Maryland

Key Operational Updates & Reminders

• Holiday timelines & content sync: Sites were reminded to review upload deadlines;

provider emails depend on timely uploads. “Content Sync” will not function until the winter

upgrade to the MPOG App Suite is applied. Release notes will be posted with quality-of-life

improvements and bug fixes. Coordinate with your technical team as database updates may

be required.

o Current Maintenance Schedule: 2025_Maintenance-Schedule_All.pdf

o New Maintenance Schedule: 2026_Maintenance-Schedule_All.pdf

o Release Notes for November 2025 Upgrade: available on the MPOG website by

12/5/2025

• QI Reporting Tool migration: The QI Reporting Tool is moving to a new development

platform (same stack as other MPOG apps). Features remain the same on day one; the

change enables faster future enhancements. Report any issues to the Coordinating Center.

• Location Mapping Utility: Please map all locations; this is increasingly important for

research analyses and QI reviews. Coordinating Center may follow up with sites with

unmapped rooms.

• Ambulatory Glycemic Management Workgroup: New workgroup to shape ambulatory

glycemic management specifications is meeting next month. Measure concepts may overlap

with general measures but the focus is ambulatory surgery cases.

• 2026 Measure review plan: Mostly finalized. Quality champions interested in participating

(especially those who have not previously reviewed) are encouraged to reach out.

QC Date

Measure

Reviewer

Institution

1/26/2026

OME

Clark Fisher, MD, PhD

Yale New Haven Health

2/23/2026

TOC-02

Alvin Stewart, MD

University of Arkansas for Medical Sciences (UAMS) Medical Center

TOC-03

Alvin Stewart, MD

University of Arkansas for Medical Sciences (UAMS) Medical Center

5/18/2026

GLU-09

Patrick Henson, MD

Vanderbilt Health

GLU-10

Patrick Henson, MD

Vanderbilt Health

GLU-11

Patrick Henson, MD

Vanderbilt Health

GLU-12

TBD

GLU-13

TBD

7/27/2026

PONV-03

Tariq Esmail, MB Bch

University Health Network

9/28/2026

BP-01

Jonathan Paul, MD

Columbia University Medical Center

BP-03

Jonathan Paul, MD

Columbia University Medical Center

BP-06

Jonathan Paul, MD

Columbia University Medical Center

FLUID-01

Ayesha Bryant, MD,MPH

University of Alabama Birmingham Health System

11/23/2026

AKI-01

Mike Mathis, MD

University of Michigan Health

NMB-04

Megan Anders, MD

University of Maryland

• Recent minor measure updates were posted; they do not materially affect scores.

o AKI-01: Updated additional info to result highest and lowest eGFR & Preop

Creatinine (most recent)

o BP-07-C: Updated measure result reasons to separate flagged results based on BP

route

o FLUID-01-C, FLUID-01-NC, FLUID-02-C, FLUID-01-NC: Updated measures to only

consider non-zero values for flagged cases

o GLU-09, GLU-10, GLU-11, GLU-12, GLU-13: Updated measure case report column to

report the correct phase of care for flagged cases

o NMB-02: Updated exclusion order to result ‘patient extubated: No’ when an

extubation time is not found for the case

o NMB-03-P: Updated to exclude cases where duration from first NMB dose to

extubation <180 minutes; excludes emergency case

o SUS-02: Updated logic to remove multiplication x60 for cases less than 60 minutes

(do not normalize to one hour - result only total kg CO2 eq)

o TEMP-04-Peds: Update cardiac exclusion to reference the Peds Cardiac phenotype

to exclude Cardiopulmonary bypass cardiac cases (value code = 1)

o TEMP-07-C: Updated measure result reasons to separate flagged results based on

TEMP route

2026 Meetings & Events

• MSQC + ASPIRE Combined Meeting: Friday, March 13 (Marriot, East Lansing).

• ASPIRE-only Meeting: Friday, July 17 (Weber’s Hotel, Ann Arbor).

• MPOG Retreat: Friday, October 16 (San Diego).

Sites outside Michigan are welcome at the Michigan in-state meetings—contact the

Coordinating Center for details.

Measure Review #1 — PUL-01 (Tidal Volume), Reviewer: Joseph McComb, MD (Temple University)

Measure Description: % of intubated adult general anesthesia patients with median tidal volume

<10 mL/kg predicted body weight (PBW).

Literature since the last review:

• No new RCTs directly comparing cutoffs.

• Several meta-analyses support low tidal volume with PEEP versus no PEEP.

• Strongest outcomes when used as part of a bundle (low VT + PEEP ± recruitment

maneuvers).

Reviewer recommendations:

1. Add exclusion for bronchoscopy-only cases (long, invasive bronchoscopies where scope

remains in the airway for most of the case).

2. Consider relocating the tidal-volume distribution graphic to the PUL-03 page to centralize

ventilation visuals.

3. Explore a bundled metric combining VT <10 mL/kg + PEEP (e.g., PEEP ≥4).

4. Consider a separate look at one-lung ventilation (OLV) cases rather than excluding them

without visibility.

Discussion highlights:

• ICU practice commonly uses driving pressure targets; OR adoption is variable.

• Broad support for a bundled approach (precedent exists—e.g., antibiotic bundles in cardiac).

• BMI/procedure context matters for appropriate PEEP; future visualizations could stratify by

BMI.

Vote & Decision:

• Modify PUL-01 to add bronchoscopy-only exclusion.

• Strong support to scope a new bundled measure (VT + PEEP).

• Less support to build a separate OLV measure now (depends on accurate case

identification).

Measure Review #2 — PUL-03 (PEEP Use), Ketan Chopra, MD (Henry Ford – Detroit)

Measure Description: % of intubated adult general anesthesia cases with median PEEP ≥2 cm H₂O

Evidence Review:

• Consistent harm with ZEEP; low-level PEEP is standard of care.

• No evidence that fixed higher PEEP (8–10) universally improves outcomes; may increase

hemodynamic events.

• OLV (PROTHOR): PEEP 10 vs. 5 showed no PPC reduction with higher PEEP and more

hypotension; points to individualized PEEP over fixed targets.

• Emerging approaches (driving pressure, compliance, EIT, recruitment-to-inflation ratios)

suggest benefit but are not yet ready for a standardized MPOG metric.

Reviewer recommendations:

• Maintain the 2 cm H₂O floor (prevents ZEEP) and clarify it is a floor, not an optimal target.

• Add/retain a PEEP histogram/breakdown visualization on the PUL-03 summary page to

better show department patterns; consider refining bins for more nuance.

• Consider bundling with PUL-01 to increase actionability.

Vote and Action Items:

• Keep PUL-03 as-is (still valuable for new sites and learners).

• Move/standardize PEEP breakdown as a visualization (not a measure change).

• Support for a bundled PUL-01 + PUL-03 measure.

• Coordinating Center to add PEEP breakdown visualization on PUL-03’s measure summary

page.

• Incorporate BMI stratification patterns into future visualization enhancements.

New Informational Measure — TRAN-05 Cardiac

Measure Description: Adult open cardiac surgery patients who receive a transfusion and have

coagulation testing performed (e.g., TEG/ROTEM).

Purpose: Illuminate diagnostic testing variation during transfusion episodes.

Site reminder: Check your mappings for coagulation testing (TEG/ROTEM naming/capture can be

patchy). Unexpected results often reflect mapping gaps.

Best-Practices Exchange Proposal

Concept: Add short, low-prep “how we do it” spotlights during Quality Committee (or adjacent

forums) where a high-performing site or a “big mover” briefly shares workflow/policies/culture that

drove success on a measure; interested sites can connect offline for deeper dives.

Feedback themes:

• Useful especially for newer sites or areas with stalled traction.

• Consider two lenses: (1) always-high performers (culture/process) and (2) intentional QI

improvers (PDSA, reminders, education).

• Opportunities to showcase at pre-ASA or the MPOG Retreat in addition to Michigan’s

collaborative meeting existing “QI stories”

Action items:

• Coordinating Center to draft a proposal (format, cadence, topic pipeline, volunteer

champions) and bring it back to QC.

• Note interested volunteers (e.g., for train-of-four) and begin scheduling.

Meeting Adjourned: 1100

Next meeting: Monday, January 26, 2025

Appendix A — Full Transcript

ASPIRE Quality Committee — November 24, 2025

(Original wording preserved, but sentence structure, punctuation, and flow corrected for clarity.)

Part 1: Opening, Announcements, & Reminders

Brad Phillips (MD Anderson) [chat]: Good morning! 󷇱󷇳󷇲

10:04:41 — Nirav J Shah (MPOG):

As you know, in general, we have a fairly predictable schedule. We modify that a bit for the holidays.

Please take a look at it and make sure that you're aware of the upload deadlines, which is important

because that affects when provider emails can go out.

As you know, deviations apply for sites participating in MPOG clinical trials, such as Vega-2, IntraopOx,

or Thrive. Your schedule may be different, so you should adhere to the clinical trials maintenance

schedule, which is a little more frequent.

Any questions about that? Don't hesitate to reach out to anyone here at the Coordinating Center, and

we can help you out.

Good news: The MPOG App Suite winter upgrade will be released next week. We'll post our release

notes on the website so folks have detailed information about what's in it. Just an important reminder:

Content Sync will not work until you apply the upgrade, so please apply it as soon as reasonably

possible.

It’s not a huge release for us, but we did make some quality-of-life improvements and a couple of bug

fixes in various areas. Take a look at the release notes as well. Again, try to apply the upgrade as soon as

possible. You may have to work with your technical team to make the database updates, and Chris

Heiden from our team is on top of that.

Any questions? Don't hesitate to reach out to us. It should be released next week, after the holidays.

Speaking of releases, we are releasing an update to the QI Reporting Tool. There are no new features,

but we're migrating to a new development platform, which sets us up nicely for future updates and

upgrades to the QI Reporting Tool, especially as other parts of MPOG start to use this application for

their reporting needs.

This platform is on the same development stack as other MPOG applications. You should see that later

today, maybe tomorrow. There is no difference—same login. When you log in, you should see exactly

what you've seen before. Some of the look and feel may be a little different, but the features, at least on

day one, will be exactly the same.

We're excited about this new platform. It will allow us to build new features more quickly. It's on a more

common development platform than we were using previously, and we're excited about that. Big thank

you to our technical team for putting in a lot of time and effort for this migration.

If anyone sees any issues or finds anything that's weird, definitely let us know as soon as possible. That

new platform should be available either later today or maybe tomorrow.

Another reminder: Please map all your locations in the Location Mapping Utility. This is now coming into

play more and more as research projects use location mapping as part of their analysis. It also helps

from a QI perspective when reviewing cases. On the research side, it's becoming very useful.

We're noticing some unmapped rooms. We'll probably reach out individually to some sites that need to

do this, but we wanted to send out a broader communication too. Thank you so much for working on

that. Any questions so far?

A couple of upcoming events: Next year’s dates are all set.

• Friday, March 13 for our combined MSQC Aspire meeting in East Lansing. We're excited about

partnering with MSQC, the general surgery Quality Collaborative in Michigan.

• Our Aspire-only meeting will be Friday, July 17.

• The MPOG Retreat will be Friday, October 16 in San Diego.

Huge thank you to everyone who attended the 2025 retreat, either virtually or in person. It was really

fun and great to connect with so many of you and hear from wonderful speakers. Hoping many of you

can join next year in sunny San Diego.

For sites outside Michigan, if you're interested in coming to the Michigan meetings, you are welcome.

Please reach out to anyone here at the Coordinating Center, and we can describe what those meetings

are about.

We did have one follow-up to share from the retreat and our September meeting. We were talking

about glycemic management in the ambulatory space. There's been some work over the past few weeks

to communicate with those who expressed interest in participating in the glycemic management

workgroup.

Thanks to everyone for responding quickly to the Doodle poll. A meeting invite just went out earlier this

morning. If you received that, you shared your interest. If you haven't received it or haven't shared your

interest but would like to join, please let us know, and we'll add you.

This workgroup will decide the specifications for glycemic management measures related to the

ambulatory space. Some discussions may overlap with regular measures, but the focus will largely be

ambulatory patients.

I also want to share that we're pretty much finalized with our measure review plan for 2026. Thank you

to everyone who agreed to be a measure reviewer next year. We still have a couple of measures to

figure out.

The measure review process is so important to ensure measures stay current and responsive to

literature and feedback from participating sites. We'll send out a communication regarding the schedule

in the upcoming weeks, but I wanted to share early information.

If you haven't participated as a reviewer and are interested, please reach out. We may reach out to you

as well. If you have interest in a specific anesthetic domain, let us know, and we can add you to the pool

of reviewers.

We review measures every three years, and that cadence works well. If you haven't reviewed a measure

yet and there's a domain of interest, please reach out.

Just a couple of updates before we get to the measure reviews: We've made minor updates across many

measures in the last couple of months. None of these materially affect scores. They're posted on our

website and added to these slides. If anyone has questions, let us know.

Okay, with that, any comments or questions? Anything I missed from the Coordinating Center team? If

not, we can get to the first review. Dr. McComb, are you all set to go?

Part 2: Measure Review — PUL-01

10:14:47 — Joseph McComb (Temple University):

Okay, so what we're reviewing here is Pulmonary 01. This measure looks at the percentage of patients

with tidal volumes less than 10 mL per kg of predicted body weight. The inclusions for that are patients

undergoing endotracheal intubation. Those are the cases included. The exclusions are on the next page.

Of note, for those who remember, this was reviewed a while ago. It used to look at less than 8 mL and

10 mL, and then we decided to make it 10 mL. That was just historical, if you remember that. Next slide,

please, Nirav.

Joseph McComb (Temple University):

These are the exclusion criteria: age less than 12, organ procurement, very brief mechanical ventilation,

Prostinol use, missing height or sex (because then you can't calculate predicted body weight), one-lung

ventilation, and weight less than 20 kilograms.

Next slide. Since the last review, there have not been any new randomized studies to compare this in

depth. There have been several meta-analyses, and the key findings are pretty good. In the document

we sent out, we listed those meta-analyses. They did a nice job of not just presenting the 16 or 20

studies in each review, but also including a bias ranking, which was part of the discussion previously

when the measure changed. Many of the older randomized controlled trials had moderate bias,

especially those comparing low volumes between 8 mL and 10 mL.

However, with that being said, there is strong support for less than 10 mL per kilo with PEEP, and that

was found to be superior to no PEEP. The strongest evidence shows that when you have a bundle—a

triad of low tidal volume, PEEP, and recruitment maneuvers—you get decreased postoperative

pulmonary complications and minimize intraoperative cardiac complications such as hypotension and

bradycardia.

What we didn’t see was an easy way to measure individualized PEEP or track whether recruitment

maneuvers were used. Of the three things, what we can measure—and have been measuring—is tidal

volume less than 10 mL per kg.

Although there are biases in some studies, we like the current reporting mechanism that shows less

than 10 mL as the success measure but breaks it down into 6–8 and 8–10. We find those buckets helpful

for two reasons:

1. If future literature supports less than 8 as superior to less than 10, we’ll have that data.

2. It may provide data for someone to study associations with decreased complications.

This is our data at Temple. We had been suggesting 6–8 before the change, and we left that there as our

suggestion. As you can see, the middle two bars—the second one, the tallest—is 6–8, and the next one

is less than 10. What we found is like driving the speed limit: if the limit is 55, people will do 65. So if we

encourage 8, we hit 100% with 10.

Dr. Kraus and I reviewed this together. We feared that if we got rid of 8, we’d start seeing 11 and 12. So

for those reasons, we think it’s nice to still present those buckets. Also, there’s no study showing that 8

is harmful. We didn’t find strong literature to change the success measure.

Our final recommendation: Yes, we should continue this measure but with modifications.

• First, we’ve started seeing very invasive, long bronchoscopies with IONs and other tools where

the bronchoscope stays in the airway most of the case. We think those should be excluded if the

entire case is bronchoscopy-only. If it’s bronch plus thoracotomy or another case, not so much—

but if the entire case is bronchoscopy, exclude it.

• Second, the heat breakdown at the bottom of the page should be moved to the Pulmonary 03

page. It’s important to keep but better displayed there.

• Third, we recommend adding a combination measure of what we can measure now: less than

10 mL plus PEEP (greater than 3, so like 4 or 5). Literature supports the bundle, and while we

can’t easily document recruitment maneuvers or individualized PEEP, we can look at tidal

volume and PEEP together.

• Fourth, we exclude one-lung ventilation now, but perhaps we should look at those cases

separately. There is some literature suggesting benefit in measuring performance for one-lung

ventilation cases.

Those are the four recommendations we came up with. Anyone have comments, questions, additions?

Part 3: Measure Review — PUL-03

10:32:32 — Ketan Chopra (Henry Ford - Detroit):

Great. Thank you so much. Hi everyone, I’m Ketan Chopra, the Aspire Champion for Henry Ford Health

in downtown Detroit. Today, I’m reviewing PULM-03.

This review will focus on the new literature. The last time we reviewed this measure was in 2022, and

we’ll talk about the current rationale, inclusion and exclusion criteria, success definition, and any

proposed changes.

Just to remind everyone: Pulmonary 03 evaluates whether adult general anesthesia cases with

intubation receive a median PEEP of at least 2 cm H₂O. This was designed to distinguish cases with no

PEEP from those with some PEEP, since providing PEEP is a lung-protective strategy.

The key question was whether there’s been any new evidence in the past few years to support changing

the threshold or structure of the measure. The short answer: Literature continues to support low-level

PEEP as standard of care but does not support a higher universal target.

I looked at recent trials and meta-analyses from the past three years. They confirm what we already

know: Lung-protective ventilation with low tidal volume and some degree of PEEP decreases

postoperative pulmonary complications compared with high tidal volume and zero PEEP. There is

consistent harm with ZEEP (zero PEEP), which validates the lower boundary of this measure.

Data does not support fixed higher PEEP (like 8 or 10). Several large analyses show no improvement in

complications and even potential harm, such as intraoperative hypotension or arrhythmia, when PEEP is

pushed to higher arbitrary limits.

Regarding one-lung ventilation, Nirav shared a recent study—the PROTHOR trial—which is probably the

most influential new study in this area. It compared high PEEP (10) versus low PEEP (5) and found no

reduction in postoperative pulmonary complications with higher PEEP, but more hemodynamic events.

This underscores that PEEP should be individualized rather than defaulted to a high number like 10.

Since 2022, the most important shift is toward individualized PEEP titration. New trials discuss driving

pressure, compliance measurements, EIT (electrical impedance tomography), and recruitment-to-

inflation ratios. These show physiologic improvement and sometimes reduced complications, but

they’re not widely adopted yet.

The current rationale remains sound: PEEP prevents atelectasis, maintains alveolar recruitment, and

reduces postoperative pulmonary risk. Low levels of PEEP are safe and standard. Higher levels may be

appropriate in certain cases, but that depends on patient factors and hemodynamic tolerance. The

distinct risk occurs when PEEP is completely omitted, which this measure aims to prevent.

Inclusion and exclusion criteria remain appropriate: ASA 5 and 6, organ procurement, cases under 45

minutes, and one-lung ventilation are excluded. Success is defined as median PEEP ≥2 cm H₂O. This

threshold is not meant to define optimal care, only to prevent zero PEEP, which is avoidable harm.

There’s no literature suggesting increasing the threshold to 5, even though most machines default to 5.

Leaving it at 2 is fine for now.

Additional feedback: Dr. McComb mentioned a graph showing PEEP breakdown. We could add this to

the Pulmonary 03 summary page. It helps clinicians visualize PEEP trends across the department and

identify patterns. We might refine the bins for more nuance—currently 2–4 and 4–8 are small ranges.

Closing remarks: Since 2022, practice has shifted from fixed PEEP protocols to physiologic titration. Best

outcomes occur when PEEP matches lung mechanics rather than chasing a universal number. Pulmonary

03 should be viewed as a floor, not a target. It prevents harm by eliminating zero PEEP but doesn’t

capture complex adjustments for individual patients.

The future may include driving pressure, recruitability, real-time lung mechanics, and AI, but for now,

the measure is appropriate and stable. Bundling with the tidal volume measure makes sense because

compliance with both is more meaningful than either alone.

Part 4: Additional Topics, New Measure, Best-Practices Exchange, & Close

10:48:34 — Nirav J Shah (MPOG):

Since we have time, I want to cover a couple of additional topics.

First, we have a new measure in the cardiac space: coagulation monitoring for open cardiac cases. This

was voted on and discussed at the cardiac subcommittee, but we want to share new measures that

come out of subcommittees because we still consider the Quality Committee as the primary governance

body.

In that spirit, TRAN-05 Cardiac is the percentage of adult patients undergoing open cardiac surgery who

receive a transfusion and have coagulation testing performed. This is intended as an informational

measure to help sites understand variation in diagnostic testing during transfusion episodes.

Any questions or comments on TRAN-05 Cardiac?

Allison Janda (MPOG):

One public service announcement: Some sites are patchy about how they map coagulation testing

measures, especially for TEG and ROTEM. If you see unexpected results, please check your mappings.

We’ve encouraged this through the cardiac subcommittee, but this is a good forum to repeat that

reminder.

Nirav J Shah (MPOG):

Awesome. Thank you, Allison.

The final topic is something we’ve been thinking about for a while, and we’d like feedback from the

group. One of the things we’ve done—both at the Coordinating Center and in Michigan—is connecting

high-performing sites with others that want to improve.

We’ve done this in a couple of ways:

• At in-person Quality Committee meetings in Michigan, we unblind performance across hospitals

and share ideas that work well, things that haven’t worked, and give folks a forum to talk about

challenges and opportunities.

• At the Coordinating Center, we also connect sites outside Michigan with high-performing sites

around the country.

Out of these experiences, we thought it might be helpful to do something similar alongside our measure

reviews. Here’s the idea: For selected measures—especially those with variation in care or where some

sites struggle—we could ask a strong performer (a quality champion) to share what they do at their

institution. This could include workflow, policies, processes, or culture that help them succeed.

We’d ask them to share a few thoughts during a Quality Committee meeting. Minimal preparation—

maybe a few slides if they want, but not required. The goal is to start sharing and take advantage of the

amazing work happening across the country.

Is there interest in this? Would it be useful? Or are there other ways you’d prefer to get this

information?

Kunal Karamchandani (UT Southwestern) [chat]:

Maybe at the pre-ASA meeting, have very high-performing sites present their QI interventions to share

with others.

Nirav J Shah (MPOG):

Great suggestion.

Feedback from group:

• Mason [chat]: I’m in favor of this.

• Michael Mathis (MPOG): Best performers can share useful information, and “big movers” can

too—sites that improved quickly can explain what drove that change.

• Chris Wedeven, M.D. [chat]: Yes, great idea!

• Ashanpreet Grewal (Maryland) [chat]: Great idea, especially for newer sites or those struggling

to gain traction.

• Tariq Esmail (Toronto): I’d add that it’s helpful to distinguish between sites that have always

been strong and those that improved through intentional QI projects. Both perspectives are

valuable. For example, we’ve been working on train-of-four monitoring with PDSA cycles,

reminders, and education sessions. I could talk for an hour about what we’ve done, but the key

is sharing high-level strategies.

Joseph McComb (Temple University):

I agree. Maybe one meeting a year could be like a mini poster session—quick 5–10 minute talks, like ASA

Snap Talks. Then anyone interested can connect offline for more detail.

Xan Abess (Dartmouth) [chat]:

Train-of-four monitoring is our six-headed hydra.

Nirav J Shah (MPOG):

Great ideas. We’ll note interest in train-of-four monitoring for a future ad hoc session. There’s support

for this concept, so we’ll develop a proposal and bring it back to the committee.

Closing:

Thank you to the measure reviewers and everyone who contributed. Happy Thanksgiving! I hope most

of you are not on call. For those who are, thank you. Take care, everyone.