MPOG Cardiac Anesthesia Subcommittee Meeting
April 14, 2026
Agenda
•Introductions and Announcements
•December 2025 Meeting Recap
•Measure review schedule and dashboard access
•TRAN-01 Discussion
•Subcutaneous Insulin Handling and attribution in Cardiac Glucose Measures
•GLU-14-C Measure
•Next Measure Discussion
•Summary and Next Steps
Announcement
New Cardiac Subcommittee Vice Chair
Congratulations
Dr. Ashan Grewal!
Dr. Grewal is a cardiothoracic anesthesiologist at the University of
Maryland. An active member of the MPOG Cardiac Anesthesia
Subcommittee, he has contributed to cardiac measure
development and review, including proposing the GLU-14-C
measure and reviewing TEMP-07-C, while also serving on MPOG
Quality and PCRC committees. As Associate Director of Quality in
his department, he leads efforts to translate MPOG data into
meaningful clinical change.
Introductions
•ASPIRE Quality Team
–Allison Janda, MD –MPOG Cardiac Anesthesia Subcommittee Chair
–Ashan Grewal, MD –MPOG Cardiac Anesthesia Subcommittee Vice Chair
–Megan Charette, BSN, RN, MPH, MBA –MPOG Cardiac Subcommittee Facilitator
•Cardiac Anesthesiology Representatives joining us from around the US!
December 2025 Meeting Recap
Allison Janda, MD
December 2025 Meeting Recap –Key Highlights
•New measure: GLU-14-C approved for development –update & discussion today
•Measure updates:
oTRAN-05-C: Refined definition; variability linked to data mapping gaps
oGLU-06-C and GLU-07-C: Attribution fix; updated results reflected as of Jan 2026
•Unblinded performance review takeaways:
oFocus on earlier intervention strategies
oImprove data mapping and validation
oShare and adopt best practices across sites
2026 Measure Reviews
•Three measures due for review
•Reviewers:
oGLU-06-C & GLU-08-C: Josh Billings, MD (Vanderbilt Health)
oGLU-07-C: Rob Schonberger, MD (Yale New Haven Health)
Cardiac Dashboard Departmental Access
•Dashboard access for the cardiac subcommittee needs to be refreshed
•Departmental dashboard access is approved by the Departmental Quality Champions
as an all-or-nothing view (access cardiac dashboard as well as full dashboard)
•We will reach out to Departmental Quality Champions:
o"Please let us know who you would like to receive departmental dashboard access on behalf of the
cardiac subcommittee.”
TRAN-01 Discussion
Allison Janda, MD
TRAN-01: Transfusion Management Vigilance –Proposed Update
Background: TRAN-01 measures documentation of Hb/Hct prior to transfusion, requires lab value
within 90 minutes before transfusion –Recently updated to include open cardiac cases
Goal: Ensure data-driven transfusion decisions
Current logic:
–Allows up to 2 units after Hb ≤ 7 / Hct ≤ 21 without redraw
–Only the first qualifying lab guides transfusion logic
–Later qualifying labs are not considered
Proposed revision:
–Evaluate each qualifying Hb/Hct (≤ 7 / ≤ 21) independently
–Allow 1–2 units per qualifying lab value without redraw
–Apply logic sequentially across the case
TRAN-01 Example Case
Current Logic - FLAGGED: Updated Logic - PASSED:
Currently only the first qualifying lab guides transfusion logic, with the update each qualifying Hb/Hct (≤ 7/≤ 21)
will be evaluated independently and the logic will apply sequentially across the case.
Subcutaneous Insulin and Attribution in Cardiac Glucose
Measures
Allison Janda, MD
Subcutaneous Insulin in GLU-08
Background: Cardiac glucose measures currently emphasize IV insulin treatment –Non-cardiac
measures include logic for subcutaneous (SQ) insulin with timing considerations
Goal: Ensure accurate assessment of glucose management without penalizing appropriate
perioperative care
Current logic:
–Focuses primarily on IV insulin administration
–Does not account for delayed onset of SQ insulin
–Patients may be flagged despite appropriate SQ treatment
Proposed revision:
–Incorporate SQ insulin into cardiac glucose measure logic
–Apply timing-based considerations (e.g., recent [2h] SQ dose before glucose check)
–Align cardiac measures with existing non-cardiac glucose logic
Background: Cardiac glucose measures did not have clear attribution for glucoses that were not
checked or passed if signed in for <2h
Goal: Ensure accurate attribution of glucose management
Attribution for GLU-06: (GLU-06 and GLU-07 updated, will be updating to apply to GLU-08)
•If a glucose is checked when the provider is signed in and any values are >180 and if rechecked within 30 minutes glucose
remains and if rechecked within 30 minutes glucose remains and if rechecked within 30 minutes glucose remains >180 or not
checked within 30 minutes, then flag provider.
•If glucose is checked when the provider is signed in and all values <=180, then pass provider. (even if signed in for <2h)
•If no glucose values checked when provider is signed in but glucose was checked on the case and was <=180, then pass
provider.
•If no glucose values checked when provider is signed in but glucose was checked on the case and was >180, then evaluate if
provider was signed in for >2 hours, if yes, then flag. If signed in for <=2 hours, then exclude.
•If no glucose values checked when the provider is signed in and no glucose values checked on the case, evaluate if provider
was signed in for >2 hours, if yes, then flag. If signed in for <= 2 hours, then exclude.
•If no glucose values checked when the provider is signed in but glucose was not checked on the case AND provider is signed
in for >=2 hours, then flag provider.
Attribution in Cardiac Glucose Measures
GLU-14-C Discussion
Ashan Grewal, MD
GLU-14-C: Cardiac Hyperglycemia Successful Treatment
Background: GLU-14-C focuses on achieved glucose control—not just treatment—linking care to
improved surgical outcomes
Definition: Percentage of adult patients (≥18 years) undergoing open cardiac surgery under
general anesthesia (duration ≥120 minutes) whose last intraoperative blood glucose before
anesthesia end is ≤180 mg/dL (10.0 mmol/L).
Key criteria:
–Includes all adults (with/without diabetes)
–Evaluates the last glucose before anesthesia end
–Excludes short cases, non-cardiac procedures, ASA 6
GLU-14-C: Preliminary Performance (prior 12 months)
New Measure Discussion
Allison Janda, MD and Ashan Grewal, MD
Existing Measures
New Measure - Ideas
•Multimodal Pain (Cardiac Inclusion)
oCurrent gap: Cardiac surgery patients are excluded from PAIN-02 (Multimodal Analgesia)
oOpportunity: Align with ERACS Guidelines emphasizing pain control as a core component
oProposal:
▪Expand measure to include cardiac cases
▪Standardize multimodal analgesia protocols for cardiac surgery
oImpact: Improved recovery, guideline alignment, and more comprehensive quality tracking
•Neuromuscular Blockade Reversal in Cardiac/Fast-Track Patients
oCurrent gap: NMB-02 excludes patients not extubated in the OR, effectively omitting most cardiac cases
oOpportunity: Fast-track cardiac patients should consistently receive reversal
oProposal:
▪Adapt NMB-02 criteria to include fast-track cardiac phenotype
▪Define and standardize “fast-track” eligibility
oConsiderations:
▪Requires "fast-track" phenotype definition and workflow adjustments
oImpact: Better alignment with best practices and improved patient safety
Cardiac Anesthesia Subcommittee Membership
•Open to all anesthesiologists or those interested in improving cardiothoracic
measures
–Do not have to practice at an active MPOG institution
•Proposed 2026 Meeting Schedule
–Late July, early August
•Thank you for using the forum for discussion between meetings
