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A MULTIDISCIPLINARY ORGAN DONOR COUNCIL AND PERFORMANCE IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES. 2010 ONELEGACY CELEBRATING OUR PARTNERS May 26, 2010 Allen P. Kong, MD 1 , Cristobal Barrios, MD 1 , Ali Salim , MD 2 ,

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A multidisciplinary organ donor council and performance improvement initiative can help save lives l.jpg

A MULTIDISCIPLINARY ORGAN DONOR COUNCIL AND PERFORMANCE IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

2010 ONELEGACY CELEBRATING OUR PARTNERS May 26, 2010

Allen P. Kong, MD1, Cristobal Barrios, MD1, Ali Salim, MD2,

Lynn Willis, MHA1, Marianne E. Cinat, MD1, Matthew O. Dolich, MD1,

Michael E. Lekawa, MD1, David B. Hoyt, MD1, Darren J. Malinoski, MD1

1University of California, Irvine, Medical Center, Orange, California

2Cedars-Sinai Medical Center, Los Angeles, California


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QUESTIONS TO RUN ON… IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

  • What can my hospital do to improve its organ donation outcomes?

  • What can I do to improve donation outcomes?


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The Problem IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

As of Jan 2010:

105,452 candidates

21,425 transplants in 2009

Waiting List

Transplants

Transplants from Deceased Donors

Transplants from Living Donors


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Goals of the Organ Donation Breakthrough Collaborative IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

  • 3.75 organs transplanted per donor (OTPD)

  • 10% donors after cardiac death (DCD)

  • Increase conversion rate up to 75%

  • Increase donations by 1,900/year

  • Increase transplants by 6,000/year

Conversion rate = # actual donors / # eligible donors


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Improvement Strategies IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

Make donation a priority at large hospitals

Create DCD policies

Use extended criteria donors (ECD)

Catastrophic Brain Injury Guidelines

Donor Management Goals


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Hospital Requirements IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

  • Centers for Medicare/Medicaid Services & American College of Surgeons

    • Notification process

    • Declaration of brain death

    • Organ procurement organization (OPO) relationship

    • Performance Improvement (PI) program

    • Patient/family opportunity to donate


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Current Status IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

  • Organ donor council established in 2007 at UC Irvine


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Hypothesis IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

Establishment of an organ donor council and performance improvement initiative will lead to improved donation outcomes.


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Organ Donor Council IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

Multi-disciplinary

Transplant Surgeons

Intensivists

Nurses

Palliative Care

Ethics

OPO

Clinical Champions

Trauma Team

  • Administration

  • Chaplain

  • Operating room

  • Performance Improvement

  • Risk Management

  • Pharmacy

  • Community Representative


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Methods IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

  • Prospectively collected data on all referrals to regional OPO from 2006 to 2009

    • Number of referrals

    • Timely notification

    • Conversion rate

    • DCD rate

    • ECD rate

    • OTPD

    • Total number of organs transplanted

    • OTPED (organs transplanted per eligible death)


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2007 Areas of Focus IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

  • DCD policy

  • Brain death determination policy/protocol

  • Clinical triggers for notification

  • Binders in every critical care unit

  • Performance improvement process


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ORGAN DONATION CLINICAL TRIGGERS IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

CALL OneLegacy at 1-800-338-6112 within 1 HOUR

Call OneLegacy at 1-800-338-6112 for TISSUE/EYE DONATION

for ALL Cardiac Deaths within 1 hour of death


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Results IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES


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2008 Areas of Focus IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

  • Devastating brain injury pathway

  • Performance improvement process

  • Case reviews to evaluate:

    • Approach for consent

    • Medical donor management

    • Acceptance of organs for transplantation


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Results IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES


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Results IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

  • OTPED = effectiveness of an organ donation program

    • Considers conversion rate & donor management

p=0.20 vs. 2007

p=0.45 vs. 2007


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2009 Areas of focus IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

  • Donate Life Flag raising ceremonies

  • Donate Life Rose Parade Float team

  • CEO/Dean Letters to staff about each donor

  • Devastating Brain Injury Checklist

  • Housestaff Resource Card


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Conclusions IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

  • Development of an organ donor council and performance improvement initiative led to improvements in:

    • Timely notification

    • Conversion rate

    • DCD rate

    • OTPED

  • Overall number of organs transplanted remained stable, despite decreases in overall number of donors and organs transplanted in the region.


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THANK YOU IMPROVEMENT INITIATIVE CAN HELP SAVE LIVESDarren Malinoski, [email protected]

UC Irvine Medical Center hereby expresses its thanks for the cooperation of OneLegacy and all the organ and tissue donors and their families, for giving the gift of life and the gift of knowledge, by their generous donation.


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QUESTIONS TO RUN ON… IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

  • What can my hospital do to improve its organ donation outcomes?

  • What can I do to improve donation outcomes?


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