Cardiac Anesthesia Subcommittee Minutes

April 14, 2026

3:00pm – 4:00pm EST

Zoom

Attendance:

Tammy Atwood, Henry Ford Health

Allison Janda, MPOG

Justyna Bartoszko, University Health Network

Daniel Kinney, Yale New Haven

Peter Bow, University of Michigan

Tiffany Malenfant, MPOG

Jessica Brodt, Stanford Health

Michael McCaughan, Sparrow Health

Morgan Brown, Boston Childrens Hospital

Marie McHenry, Stanford Health

Kate Buehler, MPOG

Kam Mirizzi, MPOG

Mei Calabio, MPOG

Judy Negele, Trinity Health

Ruth Cassidy, University of Michigan

Rebecca Pantis, MPOG

Megan Charette, MPOG

Rachel Stumpf, MPOG

Deborah Claybaugh, MyMichigan Midland

Megan Rolfzen, University of Michigan

Rob Coleman, MPOG

Rob Schonberger, Yale New Haven

Vikram Fielding-Singh, Stanford Health

Nirav Shah, MPOG

Kim Finch, Henry Ford Health

Lida Shaygan, University of Texas Southwestern

Clark Fisher, Yale New Haven

Frances Guida Smiatacz, MPOG

Jackie Goatley, University of Michigan

Kirsten Steffner, Stanford Health

Ashanpreet Grewal, University of Maryland

Meridith Wade, MPOG

Jerri Heiter, Trinity Health

Melanie Herren, MPOG

Meeting Start: 15:02

1. Agenda

a. Introductions and Announcements

b. December 2025 Meeting Recap

c. Measure review schedule and dashboard access

d. TRAN-01 Discussion

e. Subcutaneous Insulin Handling and attribution in Cardiac Glucose Measures

f. GLU-14-C Measure

g. Next Measure Discussion

h. Summary and Next Steps

2. Announcement

a. Dr. Ashan Grewal introduced as new Cardiac Subcommittee Vice Chair

3. Introductions

a. ASPIRE Quality Team

i. Allison Janda, MD – MPOG Cardiac Anesthesia Subcommittee Chair

ii. Ashan Grewal, MD – MPOG Cardiac Anesthesia Subcommittee Vice Chair

iii. Megan Charette, BSN, RN, MPH, MBA – MPOG Cardiac Subcommittee Facilitator

b. Cardiac Anesthesiology Representatives joining us from around the US and Canada

Sites encouraged to expand participation and share meeting invitations across

disciplines – anesthesia, perfusion, ACQRs, quality stakeholders.

4. December 2025 Meeting Recap

a. Introduction of GLU-14-C (end-of-case glucose control)

b. Data mapping improvements for TRAN-05-C

c. Attribution updates for GLU-06-C & GLU-07-C

d. Unblinded measure review findings:

i. Need for earlier intervention strategies

ii. Data mapping variability across sites

iii. Need for improved dashboard clarity (flag explanations)

iv. Sharing of best practices across institutions

5. Measure Review Schedule and Dashboard Access

Measures scheduled for Summer 2026 review:

Measure

Reviewers

GLU-06-C: Hyperglycemia Management

Josh Billings, Vanderbilt

GLU-07-C: Hypoglycemia Management

Rob Schonberger, Yale

GLU-08-C: Hyperglycemia Treatment

Josh Billings, Vanderbilt

Definitions: Hyperglycemia: ≥180 and Hypoglycemia: ≤70

Dashboard access has transitioned from sub-specialty specific to department-level dashboard

access.

 Access must be granted by the site quality champion

 Decision: MPOG to reach out to each site to confirm current users and additional users

still requiring access

6. TRAN-01 Discussion

The committee reviewed proposed updates to TRAN-01, which evaluates appropriate laboratory

documentation prior to transfusion and now includes cardiac cases.

Analysis showed a significant change in performance across sites after adding cardiac cases,

prompting review of the current measure logic. The existing specification allows up to two units

of transfusion following a hemoglobin ≤7 based on a single qualifying lab value, but only applies

this logic to the first low hemoglobin.

To better reflect clinical practice, the group discussed updating the measure to:

 Evaluate each hemoglobin ≤7 independently, rather than only the first occurrence

 Allow 1–2 units of transfusion per qualifying lab value without requiring an immediate

redraw

This change is intended to align the measure with real-world transfusion practices in cardiac

surgery and reduce inappropriate case flagging.

Decision: No objections were raised. The committee agreed to proceed with updating and

validating the revised TRAN-01 logic with cardiac case inclusion.

7. Subcutaneous Insulin and Attribution in Cardiac Glucose Measures

Subcutaneous Insulin Logic

The committee reviewed limitations in current cardiac glucose measures, which primarily focus

on IV insulin and do not account for the delayed onset of subcutaneous (SQ) insulin. As a result,

some cases may be inappropriately flagged despite appropriate perioperative glucose

management.

To address this, the group proposed:

 Incorporating SQ insulin into cardiac glucose measure logic

 Applying timing-based considerations (e.g., excluding glucose checks within ~2 hours of

SQ insulin administration)

 Aligning cardiac glucose measures with existing non-cardiac glucose logic

These updates aim to ensure accurate assessment of glucose management without penalizing

appropriate care.

Decision: No concerns were raised. The committee approved incorporation of SQ insulin logic

with a 2-hour timing window and alignment with non-cardiac glucose measures.

Attribution Updates

The committee addressed gaps in provider attribution, particularly clinicians signed in for less

than 2 hours, which previously led to inconsistent or inappropriate feedback.

Updated attribution logic (implemented for GLU-06 and GLU-07; planned for GLU-08) includes:

 Providers are credited (pass) if glucose is appropriately checked and controlled (≤180),

even if signed in <2 hours

 Providers are flagged if hyperglycemia (>180) is not rechecked or treated within

expected timeframes

 Providers signed in ≤2 hours are excluded from attribution when they had limited

opportunity to influence care

 Providers signed in >2 hours remain accountable for missed glucose checks or untreated

hyperglycemia

These changes standardize attribution across glucose measures and ensure feedback is fair,

clinically meaningful, and reflective of provider responsibility.

Decision: No objections were raised. The committee agreed to extend the updated attribution

logic to GLU-08 and maintain consistency across all glucose measures.

8. GLU-14-C Discussion

The committee reviewed GLU-14-C, a proposed measure presented by Dr. Ashan Grewal,

focused on achieving glucose control rather than treatment alone. The measure evaluates the

percentage of adult patients undergoing open cardiac surgery (duration ≥2 hours) whose final

intraoperative glucose prior to anesthesia end is ≤180 mg/dL.

The measure includes all adult cardiac cases (with or without diabetes) and excludes short cases,

non-cardiac procedures, and ASA 6 patients. A proposed performance benchmark of 90%

compliance was discussed.

Preliminary data show that approximately 50% of institutions fall below the target, highlighting

a meaningful opportunity for improvement. The group noted that this measure aligns with

existing literature, emphasizing the importance of limiting the duration of hyperglycemia and

optimizing postoperative glycemic control.

The committee expressed strong support, noting the measure is clinically relevant, outcome-

focused, and actionable.

Decision: No objections were raised. The committee approved GLU-14-C to proceed to final

validation and production, with anticipated availability on the May dashboard.

9. New Measure Discussion

The committee discussed potential new cardiac-specific quality measures, focusing on adapting

existing general MPOG measures to better reflect cardiac practice.

Multimodal Pain (Cardiac Inclusion)

Cardiac patients are currently excluded from the PAIN-02 (Multimodal Analgesia) measure

despite alignment with ERACS guidelines emphasizing multimodal pain management as a core

component of recovery. The group discussed expanding this measure to include cardiac cases,

with potential refinement of cardiac-specific analgesia components. Benefits include improved

recovery, better guideline alignment, and more comprehensive quality tracking.

Neuromuscular Blockade (NMB) Reversal

The committee also reviewed adapting NMB-02 for cardiac patients. Current exclusions (e.g.,

patients not extubated in the OR) omit most cardiac cases. The proposal includes incorporating

cardiac patients—particularly fast-track populations—into the measure, with consideration for

defining a “fast-track” phenotype. The group noted potential challenges with data capture and

variability in practice but agreed that tracking reversal remains clinically important and aligned

with best practices.

Additional discussion highlighted:

 Potential to initially implement measures as informational (non-punitive)

 Challenges in defining fast-track eligibility and data limitations

 Interest in future measures (e.g., refined transfusion practices, extubation timing)

Decision: The committee agreed to proceed with development of a neuromuscular blockade

reversal measure first, given its relative feasibility, with plans to subsequently develop a cardiac-

specific multimodal pain measure after further refinement and discussion.

10. Summary and Next Steps

Allison emphasized that the Cardiac Anesthesia Subcommittee is open and inclusive, welcoming

participation from both anesthesiologists and non-anesthesiologists, including individuals from

non-MPOG institutions.

The next meeting is planned for summer 2026 (late July–early August), with a subsequent

meeting anticipated in late 2026 (November–December). The summer meeting will focus on

refining measure specifications discussed during this session, while the late-year meeting will

likely include an unblinded review of measures.

Draft measure specifications will be shared via Basecamp for ongoing collaboration and

feedback between meetings.

Meeting adjourned: 16:00

Full Transcript

00:09 – Allison Janda (MPOG): Great. Well, I think we have a number of people who are here, so I’ll start

sharing my screen and we can get started with the meeting. Thank you, everybody, so much for joining.

Really excited to kick off our April meeting of the MPOG Cardiac Subcommittee. We’ll start with some

introductions and announcements, do a brief recap of the December 2025 meeting, go through the

measure review schedule and dashboard access updates that we’ll be doing this spring, go through the

TRAN-01 discussion, updates on the glucose measures including incorporation of subcutaneous insulin

handling and attribution updates for our glucose measures, and then I’ll hand off to Dr. Grewal, who’s

our new vice chair of the subcommittee, for the GLU-14 measure, and then also really encourage input

and robust discussion for next measures to be developing from this group. We’ll let that percolate as

we’re talking through the rest of the items today, but that’s what we’ll end with, so I’m looking forward

to that rich discussion. Again, congratulations to Dr. Grewal. He’s our new Cardiac Subcommittee vice

chair. He is a cardiothoracic anesthesiologist at University of Maryland, and he’s been very active both in

MPOG and on the MPOG Cardiac Anesthesia Subcommittee. He’s contributed to some of our measure

reviews and has also proposed the GLU-14 measure, which is the last glucose being less than 180 at the

end of the case that we’ll talk about more today. Congrats to him for obtaining this position. Really

looking forward to working with you more than we already have, and excited to expand the Cardiac

Subcommittee leadership outside of MPOG Central as well.

00:11 – Nirav Shah (MPOG, via chat): Congrats Ashan!

00:11 – Ashan Grewal (University of Maryland, via chat): Thank you

And just a few introductions if this is your first call. I’m Allison. I am one of the cardiac anesthesia faculty

here at University of Michigan and the chair of this group for MPOG. As I mentioned, Ashan is the vice

chair from University of Maryland. Megan is one of the newer members to our team. She is the MPOG

Cardiac Subcommittee facilitator and has been doing an outstanding job, so big thanks to her for helping

prep the meeting content and these slides. Meridith Wade is also on this team and has been helpful as

well getting everything situated. And then we really appreciate everybody joining this call from around

the U.S. and Canada. We really welcome both anesthesiologists and non-anesthesiologists on this call—

ACQRs, perfusionists, and other quality stakeholders—so please don’t hesitate to forward this invite if

you feel like you have other folks who would like to contribute.

So first, we’ll go through some of our December 2025 meeting recap. The key highlights were that Ashan

presented the GLU-14 measure, which was submitted for development. We discussed it at our

December meeting, and today we’ll be updating and discussing developments in that measure and

voting to approve production. We also did some measure updates with TRAN-05 and GLU-06 and GLU-

07 for fixing some variability and data mapping gaps, and attribution updates that were implemented in

January 2026. We also had unblinded reviews of our cardiac measures so far, and the big takeaways

were focusing on earlier intervention strategies, improving data mapping and validation at the site level,

and improving how we present this data—adding additional flags or explanations for flagged cases—and

sharing best practices across institutions. In 2026, there are three measures up for review that we will

review at our summer meeting: GLU-06, GLU-07, and GLU-08, with hyperglycemia defined as greater

than or equal to 180 and hypoglycemia defined as less than or equal to 70. Those measures are being

reviewed by Dr. Billings and Dr. Schonberger, and we’ll coordinate scheduling with them.

One other public service announcement is that the cardiac dashboard access is going to be refreshed

this spring. There are a number of folks who currently have access to the cardiac subcommittee

dashboard, but we’ve expanded all dashboard access to be department-level rather than sub-specialty-

specific. Access will need to be approved by the Departmental Quality Champion for MPOG, and we will

be reaching out to confirm who should maintain access and who else should be added. We will include

everyone on this subcommittee in that outreach and also ask sites to identify any additional users who

should have access. If there’s someone at your institution who is not currently involved but should be,

please let us know and also notify your site champion.

00:17 – Ashan Grewal (University of Maryland, via chat): Will that be the same for peds and OB

subcommittee—access to those dashboards will grant access to full dashboard?

00:17 – Meridith Wade (MPOG, via chat): Yes

00:18 – Allison Janda (MPOG): Moving on to TRAN-01, this is our transfusion management vigilance

measure. It evaluates documentation of hemoglobin or hematocrit prior to transfusion and requires a

lab value within 90 minutes before transfusion. This measure was recently updated by the General

Quality Committee to include open cardiac cases, and during validation we saw a significant change in

performance across sites after adding cardiac cases. The current specification allows up to two units of

transfusion following a hemoglobin less than or equal to 7 based on a single qualifying lab value, but this

logic only applies to the first low hemoglobin. To better reflect clinical practice, we discussed updating

the measure to evaluate each hemoglobin less than or equal to 7 independently rather than only the

first occurrence, and to allow one to two units of transfusion per qualifying lab value without requiring

an immediate redraw. This would align the measure with real-world transfusion practices and reduce

inappropriate case flagging. Does anybody have any issue or objections with that update? Hearing none,

we will proceed with updating and validating that revised logic.

00:21 – Allison Janda (MPOG): The next topic is updates to the glucose measures, specifically

incorporating subcutaneous insulin handling and updating attribution logic. Currently, cardiac glucose

measures focus on IV insulin and do not account for the delayed onset of subcutaneous insulin, which

can lead to cases being flagged even when appropriate care was provided. We are proposing

incorporating subcutaneous insulin into the cardiac glucose measure logic and applying timing-based

considerations, specifically excluding glucose checks within approximately two hours of subcutaneous

insulin administration. This aligns cardiac glucose measures with non-cardiac logic and ensures

appropriate care is not penalized.

00:24 – Nirav Shah (MPOG): I do have one question—how often is subcutaneous insulin

administered for cardiac cases?

00:24 – Allison Janda (MPOG): Not intraoperatively. IV insulin is recommended intraoperatively,

so this primarily reflects preoperative or floor management. For example, a patient coming from

the ICU or floor may have recently received subcutaneous insulin, and it wouldn’t be

appropriate to immediately re-treat before that insulin has had time to take effect. It’s a small

subset but important to capture correctly.

00:25 – Allison Janda (MPOG): The other update relates to attribution. We identified gaps for clinicians

signed in for less than two hours. The updated logic ensures that providers are credited if glucose is

appropriately checked and controlled, even if they were signed in for less than two hours, while

excluding providers who had limited opportunity to influence care. Providers signed in for more than

two hours remain accountable for missed checks or untreated hyperglycemia. These updates have

already been implemented for GLU-06 and GLU-07 and will be extended to GLU-08.

00:28 – Ashan Grewal (University of Maryland): We introduced GLU-14-C in December. This measure

focuses on achieving glucose control rather than just treating hyperglycemia. It evaluates adult cardiac

cases longer than two hours and looks at whether the final intraoperative glucose prior to anesthesia

end is less than or equal to 180. The logic has been built, and preliminary data show that a little more

than 50% of institutions are below the proposed 90% threshold, which highlights a meaningful

opportunity for improvement and provides actionable feedback for sites.

00:30 – Allison Janda (MPOG): Any questions or concerns? If not, we can proceed with final

validation and likely production for the May dashboard. This measure aligns with existing

literature emphasizing minimizing duration of hyperglycemia and optimizing postoperative

glycemic control. Hearing no objections, we will move forward.

00:32 – Allison Janda (MPOG): We’ll now move into new measure discussion. Reviewing our current

portfolio, we have cardiac-specific measures across antibiotics, AKI, blood pressure, fluids, glucose,

temperature, and transfusion practices. These have all been developed by this committee, which is a

great accomplishment.

00:37 – Ashan Grewal (University of Maryland): I reviewed general MPOG measures to identify

candidates for cardiac adaptation. Two ideas are expanding multimodal pain (PAIN-02) to include

cardiac patients and developing a neuromuscular blockade reversal measure. Multimodal pain aligns

with ERACS guidelines and would provide feedback on analgesia practices and recovery optimization.

00:39 – Justyna Bartoszko (University Health Network, via chat): Love including NMB reversal

00:39 – Jessica Brodt (Stanford Health): Both ideas are fantastic and align with ERACS consensus

work. However, neuromuscular blockade monitoring can be challenging because in some

centers, monitoring data isn’t captured due to equipment limitations, even though reversal

medications are recorded. This could impact data completeness.

00:41 – Allison Janda (MPOG): That’s very helpful context. Even if monitoring data is limited,

reversal medications may still provide a viable basis for the measure.

00:42 – Ashan Grewal (University of Maryland): For neuromuscular blockade, we may need to

define a fast-track phenotype to determine appropriate inclusion criteria.

00:43 – Allison Janda (MPOG): Defining that phenotype will be challenging, so starting with an

informational measure across all cardiac cases may be the most practical initial approach.

00:44 – Justyna Bartoszko (University Health Network): I agree. Starting with an informational

measure makes sense, and we can work toward defining a fast-track phenotype over time.

00:55 – Lida Shaygan (UT Southwestern): I’m interested in developing a more restrictive platelet

transfusion measure with more specific inclusion and exclusion criteria, though I recognize this

may be complex.

00:58 – Allison Janda (MPOG): That’s a great idea, though data limitations may make it difficult

to implement fully as a quality measure. It may be better suited initially as a research project

while we evaluate feasibility.

00:59 – Nirav Shah (MPOG): Agreed—we would need to validate diagnosis codes and assess site

variability, but it’s definitely worth exploring.

00:01:02 – Allison Janda (MPOG): To summarize, near-term priorities include developing a

neuromuscular blockade reversal measure and a cardiac-specific multimodal pain measure. Longer-term

efforts include defining a fast-track phenotype, refining transfusion measures, and exploring extubation

timing.

00:01:04 – Ashan Grewal (University of Maryland): Multimodal pain will likely require more refinement,

so neuromuscular blockade reversal may be the better measure to develop first.

00:01:05 – Allison Janda (MPOG): Agreed. We’ll proceed with neuromuscular blockade reversal first,

followed by multimodal pain, and circulate draft specifications for feedback.

00:01:07 – Allison Janda (MPOG): As a reminder, this subcommittee is open to all disciplines. Our next

meeting is planned for late July or early August, with another later in the year. Draft measure

specifications will be shared via Basecamp for continued collaboration. Thank you all for your

participation.