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High Quality Renal Transplantation: Efficiency Counts. David R. Holt, M.D., F.A.C.S. Susan Hou, M.D. David Hatch, M.D. Claudia Peano, M.D. Dadi Ding, R.N. Billie Kostro, R.N. Mary Kay Larson, R.N. Anita Pakrasi, R.N. Laura Michalski, Pharm. D. Opportunity Statement.

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High Quality Renal Transplantation: Efficiency Counts

David R. Holt, M.D., F.A.C.S.

Susan Hou, M.D.

David Hatch, M.D.

Claudia Peano, M.D.

Dadi Ding, R.N.

Billie Kostro, R.N.

Mary Kay Larson, R.N.

Anita Pakrasi, R.N.

Laura Michalski, Pharm. D.


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Opportunity Statement

Although the renal transplant program enjoyed good results with regard to rejection and survival rates, it was felt the quality of the program could be maintained while shortening the initial hospital stay and decreasing costs.

Goal: To establish a protocol for postoperative care and immunosuppression which would decrease the initial length of stay and costs for transplantation


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Most Likely Causes

  • Previous protocol for induction immunosuppression required hospitalization for infusion

  • Special laboratory tests were necessary for monitoring induction immunosuppression adding costs

  • Initial kidney function monitoring and patient follow up were performed on an inpatient basis


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Implementation

  • New induction immunosuppression protocol was devised making use of alternative immunosuppressive medications

  • Postoperative protocol modified to make more use of homecare nursing

    • Clinical follow up of patient

    • Laboratory blood draws



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Results-Cost

Average Quarterly Direct Cost for DRG 302: Kidney Transplant

Pre_Implementation

Implementation

55,000

Mean = $42,776

50,000

45,000

40,000

Mean = $35,236

Average Direct Cost

35,000

30,000

25,000

20,000

CY00-Qtr 1

CY00-Qtr 2

CY00-Qtr 3

CY00-Qtr 4

CY01-Qtr 1

CY01-Qtr 2

CY01-Qtr 3

CY01-Qtr 4

CY02-Qtr 1

CY02-Qtr 2

CY02-Qtr 3

CY02-Qtr 4

CY03-Qtr 1

Quarter


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Results-Acute Rejection Rate

  • Rejection rate within 1 year of transplant

    • 7.9%

  • All patients successfully treated and have functioning graft



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Conclusions and Next Steps

  • By revising the renal transplant induction immunosuppression protocol and making better use of homecare nursing we have reduced both length of stay and costs for renal transplantation while maintaining excellent patient outcomes.