Donation Best Practice: “HUDDLES”

1. Donation Best Practice: “HUDDLES” Pat McCabe, RN Clinical Specialist Washington Hospital Center & Inova Fairfax Hospital Presentation Questions? elizabeth@wrtc.org Elizabeth Spencer Washington Regional Transplant Consortium

2. Discussion Plan • Why “Huddle”? • Benefits to: • Hospital • OPO • Families • Steps for Implementation

3. Why “Huddle?” • To coordinate processes for best possible donation outcomes every time • To build OPO-hospital partnerships • To develop & utilize hospital-based champions to create a better donation process • To reach the goals of the Collaboratives • Increase Authorization/Conversion Rates & OTPD

4. Benefits of Huddling to the Hospital… • Sharing OPO assessment of potential options, & developing a joint game plan, increases hospital staff comfort level with donation approach • Helps guide medical preservation of those potential options • Provides staff with tools (i.e. resources, language, etc.) • Results in increased comfort with OPO Coordinators & OPO good intentions • Further solidifies OPO access & OPO-hospital staff partnership • Leadership roles within institution as “Donation Champion” • Hospital partners become participants in the donation process • Witness & assist in something positive from something otherwise only negative

5. Benefits of Huddling to OPO… Fostering vested interest in outcome/ joint accountability with hospital partners. Joint accountability for better outcomes. • OPO team in the loop on hospital’s care plan • Better ability to “follow” patient & anticipate needs • More focused pre- brain death care • Putting donation on the radar of caregivers • Medical “preservation of the donation option” (reduce # of NMS/PC) • Grave prognosis preparation (reduce # of times OPO coordinator approaches families who don’t really “get” brain death) • Internal help in problem-solving • Identification of appropriate staff to accompany OPO requestors • Assistance from an “insider” in more effectively addressing barriers (Timeliness of testing, suitability info, OR scheduling, etc.)

6. Benefits of Huddling to the Family… • The Old Days: Hospital to OPO “Pass Off” • Did the family really benefit from this strict separation? • Donation could have been seen as a scary thing from which the hospital caregivers must be disassociated • Huddles → Unified Game Plan → Continuityof Care for the grieving family • Donation as a positive part of the care continuum • Consistency in information discussed • OPO knows what the hospital knows & can reinforce message

7. Getting Started. First Steps: • Identify potential Huddle participants • Preparation & maintenance • Make “user friendly” for OPO Coordinators & hospital participants

8. Identify Huddle Participants • Core Hospital Key Players: • Attending Physician and/or Intensivist • Resident • Bedside Nurse • Charge Nurse • Add’l Hospital Staff based on structure & needs: • Soc Work, Pastoral Care, Case Management • Donation Cmte members: PI, OR administration, Clin Spec, etc. • OPO: • On-site Coordinator • Medical Director • Hospital Development/Services and/or Administrator-On-Call

9. Preparation & Maintenance • Educate key players beforehand & in real-time • Purpose • Process • Benefits • Mock Huddle Scenarios • Keep huddles brief & to-the-point with manageable # of participants • Maintain consistency: Expectation of a Huddle every time & response from all planned participants.

10. Make “User friendly” • This is yet another process in the hectic lives of the OPO Coordinators & hospital staff • “Marketing:” Ease & Benefits • Opportunity for process feedback & improvements • OPO: Develop & distribute hospital-specific contact plans for Coordinators/HD • Remove ambiguity about hospital-specific process differences • Clear outline of agreed-upon expectations (timing, participants) & participant contact information • WRTC: Organ Recovery Staff HD Resource • Utilize a template as a guide for Huddle discussion topics

11. Why You Should Huddle… • Increase the ability of the approach team to work effectively with families. • Create an atmosphere of teamwork to fix problems/dissolve barriers. • Foster partnership between hospital & OPO colleagues. • Develop sense of joint accountability for donation outcomes. Creating an “All-About-the-Ones” attitude! • Some cases, that wouldn’t have converted, will. Some organs, that wouldn’t have been transplanted, will be.

12. Questions?