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One Day Evaluation. July 22, 2014 | 3:00pm – 4:00pm ET. Save the Date!. Please Register at: Transplant Quality Resource Guide and Tools (TQRGT).

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one day evaluation

One Day Evaluation

July 22, 2014 | 3:00pm – 4:00pm ET


Save the Date!

Please Register at:


Transplant Quality Resource Guide and Tools (TQRGT)

The TQRGT is a road map incorporating best practices for developing and sustaining high quality, patient-centered excellence in donation and transplantation. Included are strategies, change concepts, actions, robust resources, templates, and worksheets intended to enhance the infrastructure and operations of all transplant programs.

To view the TQRGT, please visit:

Or go to and click on the resource tab

upcoming webinar
Upcoming Webinar

August 26, 2014 - 3:00pm ET

Donor/Recipient Communication and Confidentiality

The full 2014 Calendar of Webinars is available at, Meetings & Webinars


MichalynPelphrey, RN, MSN, ACNP, CCTC

Liver Transplant Coordinator

Comprehensive Transplant Center

Cedar-Sinai Medical Center

Los Angeles, CA


Process Improvement Group Formed in 2006

    • Surgical Director
    • Coordinators
    • Social Worker
    • Financial Coordinators
    • Management Assistants
  • Met Weekly for 2 hours for 4 months
  • Goal- Identify areas of inefficiencies in our transplant process
    • First identified area- Evaluation Process
evaluation process
Evaluation Process

Old System

  • Referral
    • Sent to Pre Transplant Management Assistant
  • Record Review
    • Pre Transplant Coordinator
  • Financial Clearance
    • Dedicated Financial Coordinators
  • Evaluation Scheduling
    • Completed by Pre Transplant Management Assistant
    • Multiple different days to complete all appointments
problems identified
Problems Identified
  • Each individual consultant and department for testing called to arrange a schedule for each patient
  • Even with best efforts, evaluation would be spread over several days/weeks
  • Areas of hold up for listing:
    • PPD testing and readings (placement and reading)
    • Dental Clearance
    • Patients missing appointments due to multiple days of scheduling
  • Enormous amounts of time trying to arrange schedules
    • Multiple departments
    • Multiple consultants
problems identified1
Problems Identified

Difficulty for patients to travel the Los Angeles area multiple days.

  • Most patients come from a distance, requiring long hours on the road for the commute back and forth.
  • Los Angeles County is over 4000 square miles with a population of over 10 million people.

Evaluations were prolonged due to all of these logistical issues.

Delay in listing patients.

ideas for solutions
Ideas for Solutions

Would it be possible to do the entire evaluation in one day?

What would it require to make this happen?

How would we get patients to and from each department in a timely fashion?

How can we resolve other factors causing delay in listing

  • Dental clearance
  • PPD testing
why one day
Why One Day?

All patients have a life threatening disease!

Cancer exception points

  • Clock is ticking

Patient Satisfaction

  • Time off of work
  • Financial hardship
  • NPO multiple days
  • Transportation
  • Compliance
next steps
Next Steps

Meetings with Departments to request weekly reserved time on one day of the week

  • Imaging Department
    • CXR
    • MRI of abdomen (5 time slots)
  • Pulmonary Lab
    • PFT’s with ABG (5 time slots)
  • Cardiac Department
    • EKG
    • Stress Echocardiograms (5 time slots)
next steps1
Next Steps

Meetings with each Consultant requesting availability for set weekly time period availability

  • Cardiology
  • Nutrition
  • Psychiatry
  • Social Work

Meeting with Dental Clinic

  • Could Dental residents see patients for dental clearance during clinic with other consultants
tracks developed
Tracks Developed
  • Made 5 Tracks of schedules
    • Each patient assigned to a Track
new system
New System


  • Intake by Pre Transplant Management Assistant

Review of Records

  • Performed by Pre Transplant Coordinator

Financial clearance for initial appointment

  • Clearance for initial Hepatology consult

Patients sent to local lab to complete evaluation lab testing

  • Serologies, tumor markers etc.

Hepatology appointment-

  • Determine suitability for full evaluation
  • Scheduled by Pre Transplant Management Assistant
new system cont
New System Cont.

Financial Clearance for Evaluation Day

  • Financial coordinators request authorization
    • Evaluation consults
    • Evaluation testing
      • Stress echo
      • PFT’s
      • CXR
      • EKG
      • MRI of abdomen
      • Labs
new system cont1
New System Cont.

Evaluation Day Scheduled

  • Held on Wednesdays
  • Scheduled with the patient and caregiver by the Pre- Transplant management assistant
  • Each patient assigned to a track
  • Track schedule emailed to each department on the Friday prior to the next Wednesday with patient name, MRN, DOB etc for each track.
  • Departments may release reserved slots at that time if all of the reserved slots are not being used for that week
evaluation day
Evaluation Day

Patients arrive at 6:15 am for registration

Met by Pre-Transplant Management Assistant and Volunteer Ambassadors to assist with registration and navigate hospital

Morning 7:00am-11:45am

  • Lab
  • PFT’s
  • EKG
  • Stress Echo

Lunch – 12:00pm-1:00pm

  • Pre transplant teaching by Coordinator
  • Box lunch for patients and caregivers
evaluation day1
Evaluation Day

Afternoon 1:00pm-4:30pm)

  • Clinic (Consults)
    • Surgery
    • Cardiology
    • Nutrition
    • Dental
    • Finance
    • Psychiatry
    • Social Work
    • Anesthesia
evaluation day2
Evaluation Day

Late afternoon (4:30pm-6:30pm)

  • Imaging
    • MRI abdomen
    • CXR

Long day

  • Approximately 12 hours
transplant ambassadors
Transplant Ambassadors

Post Liver Transplant Volunteers

Vital to completing evaluation testing

Navigate the hospital

Share experience

Benefits everyone!


Aim to assess efficiency of the one day evaluation

  • Written by Kristine Acorda, NP, Shi-Hui Pan, Pharm D and Steven Colquhoun, MD
  • Presented at NATCO meeting
  • Studied
    • Referral to evaluation time
    • Evaluation to patient selection committee time
    • Patient selection to UNOS listing time
methods for abstract
Methods for Abstract

Implemented on February 14, 2007

Study Period

  • Traditional evaluation -February 1, 2006 to January 31, 2007
  • One day evaluation- June 1, 2007 to May 31-2008
  • Learning period –February 14, 2017 to May 31, 2007
methods for abstract1
Methods for Abstract

Study patients

    • Traditional eval N=162
    • One day eval N= 153
  • Retrospective comparison
    • Referral to eval
    • Eval to patient selection
    • Patient selection to UNOS listing or denial

Statistic analysis: 2-tailed T test


Significantly reduced time

  • Eval to Patient Selection
  • Patient Selection to UNOS listing
  • Referral to eval remained the same

Efficient Transplant Evaluation


You may type a question using the Q&A box located in the bottom center of your screen, directly underneath the PPT slide.

continuing education information
Continuing Education Information
  • One Category 1 CEPTC credit is being offered for this webinar as well as a Certificate of Attendance
  • Must fill out the evaluation form; the link for the evaluation form will be sent to you via email in the next 48 hours
  • Will receive a certificate via email within one week
  • Group Leaders - Please keep a copy of your contact information sheet to track the names of the participants. You do not need to send in the contact sheet
2014 transplant
2014 Transplant

Thank you!

For more information:

Karen Libs

This webinar was made possible by Grant Number UD2HS22186 from the Division of Transplantation, Health Resources and Services Administration, U.S. Department of Health and Human Services