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Transcript of NLC 7 October 4-5, 2012 Transplant Track Performance Improvement and Risk Mitigation in...
NLC 7 October 4-5, 2012 Transplant Track
Performance Improvement and Risk Mitigation in Transplantation
Randy Sung, MDAssociate Professor of SurgeryUniversity of MichiganTony Dawson RN, MSNVice President of OperationsNew York Presbyterian Hospital
NLC 7 October 4-5, 2012 Transplant Track
Speakers
Pam Gillette, MPH, RN, FACHEMedical City Dallas
Ajay Israni, MD, MSSRTR
Linda Munro, RN, MSNHenry Ford Hospital
Sandra Shwantz, MPTMayo Clinic Rochester
NLC 7 October 4-5, 2012 Transplant Track
Surviving the Rough Waters of an SIA
Pam Gillette, MPH, RN, FACHEVice President, Transplant ServicesMedical City Dallas
NLC 7 October 4-5, 2012 Transplant Track
What is an SIA?
• Systems Improvement Agreement• Alternative step to decertification • Agreement between Transplant Hospital and
CMS• Triggers for SIA
NLC 7 October 4-5, 2012 Transplant Track
Mitigating Circumstances
• TXP Program may request the above based on these factors:• Extent to which the outcomes measures were not met• Availability of other approved transplant Centers in the area• Extenuating circumstances having a temporary effect on outcomes
• Successful requests include:• Significantly diverse populations from the national average• Plan of Correction already in place• Significant improvement in outcomes currently
NLC 7 October 4-5, 2012 Transplant Track
Elements of SIA
• Binds Hospital to improvement activities • Hospital must contract with outside monitor• Hospital pays for the team’s time & expenses• Monitor assists developing a Plan of Action• Monitor provides onsite support for plan
implementation
NLC 7 October 4-5, 2012 Transplant Track
Transplant Center’s Responsibilities
• Commitment by Hospital:• To provide resources requested by Monitor team• To make sustainable behavioral changes • To maintain a Leadership focus on the program
NLC 7 October 4-5, 2012 Transplant Track
Root Cause Analysis
• Determine what happened• Determine why it happened• Figure out what to do to reduce the likelihood
it will happen again• http://psnet.ahrq.gov/primer.aspx?
primerID=10• http://www.patientsafety.gov/CogAids/RCA/
index.html#page=page-1
NLC 7 October 4-5, 2012 Transplant Track
Steps to Success
• Transplant Team and Hospital make commitment to changes:• Organization structure• Process Improvement • Focused review of every graft loss or patient death• Re-training where needed• Standardization of immunosuppressant protocols
NLC 7 October 4-5, 2012 Transplant Track
Steps to Success
• Transplant Team and Hospital make commitment to changes:• Allocation of time for Waitlist Management• Continuing education for Transplant
Coordinators• Dedicated IT support for transplant needs
NLC 7 October 4-5, 2012 Transplant Track
Steps to Success
• Transplant Team and Hospital make commitment to changes:
• Protected time for Medical Directors• Replacing low performers at any level • No longer doing business as usual
NLC 7 October 4-5, 2012 Transplant Track
How to Reach Success
• Follow the Plan of Correction to the letter• On-site Monitor for assistance• Fully participate in required interim CMS
conference calls• Meet every goal set by the Transplant Center
NLC 7 October 4-5, 2012 Transplant Track
How to Reach Success
• Keep team motivated during process• Meet interim goals set by your team• Call your Monitor Team with questions• Remember to celebrate when the storm is
over!
NLC 7 October 4-5, 2012 Transplant Track
Contact Information
• [email protected]• 972.566.7325 office• 602.692.1190 cell
15
Performance Improvement and Risk Mitigation in Transplantation:
Making the Most of Tools and Time Provided
Ajay Israni, MD, MSDeputy Director, SRTRAssociate Professor of MedicineHennepin County Medical Center, University of Minnesota
16 16
Outline
• Scientific Registry of Transplant Recipients (SRTR) Activities as per Final Rule
• Sources of SRTR data
• Phases in the Program Specific Report Cycle
• Missing Data Reports
• Expected Survival Worksheets
17 17
SRTR Activities as per Final Rule Reporting Requirements…data shall include the following measures of inter-transplant program variation:
risk-adjusted total life-years pre- and post-transplant,
risk-adjusted patient and graft survival rates …
risk-adjusted waiting time, and
risk-adjusted transplantation rates,
…as well as data regarding patients…who were inappropriately kept off a waiting list or retained on a waiting list.
» Final Rule implemented in 2000
18 18
SRTR Data Sources for the Program Specific Reports: OPTN Data
• Transplant Candidate Registration (TCR)
• Waitlist data collection For example, MELD or LAS components
• Transplant Recipient Registration (TRR)
• Histocompatibility Form
• Deceased Donor Registration
• Living Donor Registration
• Recipient Follow-Up and Death Reporting
19 19
SRTR Data Sources for the Program Specific Reports: External Data
• Centers for Medicare and Medicaid Services (CMS) • For example, years on dialysis
Social Security Death Master File (SSDMF)
20
Phases in the Program Specific Report Cycle
21 21
Phases in the Program Specific Report Cycle: Spring/Summer Example
March 1
April 1
April 30Mid-June
Mid-July
22 22
Phases in the Program Specific Report Cycle: Spring/Summer Example
OPTN Data cut for draft release.–Data current up to this day.
23 23
Phases in the Program Specific Report Cycle: Spring/Summer Example
Data cleaned and prepared. Reports created.
24 24
Phases in the Program Specific Report Cycle: Spring/Summer Example
Draft Reports and Missing Data Sheets are posted to the SRTR Secure Site. -Observed results only.
25 25
Phases in the Program Specific Report Cycle: Spring/Summer Example
30-Day Data Review Period.
-All data changes will be reflected in the final report.
26 26
Phases in the Program Specific Report Cycle: Spring/Summer Example
OPTN Data cut for final release.–All changes made by this date will be included.
27 27
Phases in the Program Specific Report Cycle: Spring/Summer Example
Data cleaned and prepared. Final reports created.
28 28
Phases in the Program Specific Report Cycle: Spring/Summer Example
Secure Release andComment period begin. Reports and Expected survival worksheets are posted to the SRTR Secure Site.
29 29
Phases in the Program Specific Report Cycle: Spring/Summer Example
Comment period allows centers to add text that will be appended to reports.
30 30
Phases in the Program Specific Report Cycle: Spring/Summer Example
Public Release of Reports. Made available online at www. srtr.org.
31
Data Review Period
32 32
Missing Data Reports & Expected Survival Worksheets: Organization
Relate to post-transplant outcomes only.• Patient Survival (P)• Graft Survival (G)
Separates out living donor (L) and deceased donor (C) transplants.
Separates out pediatric (Pe) and adult (Ad) recipients.
Separates out different time periods• 1-month (1), 1-year (2), and 3-year cohorts (3)
This means there are MANY worksheets in each Excel file.The abbreviations above will help you differentiate between the worksheets.
33 33
Missing Data Reports & Expected Survival Worksheets: File Naming Conventions
ABCD TX1 KI L 2012 03 Missing.xls
ABCD TX1 LI C 2012 03 Expected.xls
Organ Abbreviations
Center Code
Liver Deceased-Donor Transplant
Kidney Living-Donor Transplant
Year Month Created
Kidney = KIKidney-Pancreas = KPPancreas = PA
Intestine = IN Liver = LI
Heart-Lung = HLHeart = HRLung = LU
Report Type
34 34
Worksheets in the Missing Data Reports
Data_KI_C_G_Ad_1
Page Type
Organ
Donor Type Time Period(s)
Measure: Patient or Graft
InformationMiss_KI_C_G_Ad_1_2• Program level data• Summarizes % flagged for review
Data_KI_C_G_Ad_1• Recipient level data• Identifies events and key dates• Flags items to indicate need for
review
BaseVars_KI_C_G_Ad_1• Recipient level data• Text for risk adjustment
components
35 35
Worksheets in the Missing Data Reports:Information Page
36 36
Worksheets in the Missing Data Reports:Miss_... Tab
On all worksheets the upper left corner will state if this patient or graft survival, donor type, timeframe, and the age range. Keep in mind the cohorts for patient and graft survival are different.
37 37
Worksheets in the Missing Data Reports:Miss_... Tab
Percentages of data flagged for review at the center and nationwide.
38 38
Worksheets in the Missing Data Reports:Data_... Tab
Only the observed survival is available during the data review period.
39 39
Worksheets in the Missing Data Reports:Data_... Tab
A ‘1’ indicates this graft counted as a failure for this timeframe.
40 40
Worksheets in the Missing Data Reports:Data_... Tab
41 41
Worksheets in the Missing Data Reports:Data_... Tab
Initial white columns: Items with ‘1’ flagged for review
42 42
Worksheets in the Missing Data Reports:Data_... Tab
Yellow columns on the right: Present data for certain items
43 43
Worksheets in the Missing Data Reports:BaseVars_... Tab
Data in “text” format for each transplant
44 44
Missing Data Reports:What does a ‘1’ really mean?
Purpose: • Identify potential data entry errors and omissions.• Present the data used for post-transplant outcomes.
A ‘1’ DOES NOT necessarily indicate missing data. It may also indicate (1) data that fall into “other” category, (2) data that are indicated to be “unknown”, and (3) the data are rare/unlikely values.
Examples of data commonly flagged for review:• Race of Native American or Alaska Native• BMI > 35
45 45
Reviewing Data using the Missing Data ReportsStep 1: Identify Variables for Review
46 46
Reviewing Data using the Missing Data ReportsStep 2a: Compare with data on same worksheet
47 47
Reviewing Data using the Missing Data ReportsStep 2b: Compare with data BaseVars Sheet
48 48
Missing Data Reports:Step 3 (If necessary): Review Submitted Data
Review the data your program or lab submitted:
• Transplant Candidate Registration (TCR)• Waitlist data collection • Transplant Recipient Registration (TRR)• Histocompatibility Form• Living Donor Registration• Recipient Follow-Up and Death Reporting
If necessary…• Coordinate with the OPO handling the donor or the OPTN Help
Desk to correct any omissions or errors on the Deceased Donor Registration Form.
49
Secure Release
50 50
Expected Survival Worksheets:
Purpose: • Identify cohort and data used in post-
transplant outcomes.• Facilitate sub-group analysis.
Unintended use:• Prediction of future expected numbers.
51 51
Worksheets in the Expected Survival Reports
Beta_KI-C-G-Ad-1
Page Type
Organ
Donor Type Time Period(s)
Measure: Patient or Graft
Instruction SheetData_KI-C-G-Ad-1• Recipient level data• Identifies events and key dates
Beta_KI-C-G-Ad-1• Risk adjustment information• Center and US comparisons for
each risk adjustment factor
Bl_KI-C-G-Ad-1• Baseline Survival Curve
information
52 52
Worksheets in the Expected Survival Reports:Instruction Sheet
53 53
Worksheets in the Expected Survival Reports:Data_... Tab
54 54
Worksheets in the Expected Survival Reports:Data_... Tab
55 55
Worksheets in the Expected Survival Reports:Data_... Tab
56 56
Worksheets in the Expected Survival Reports:Data_... Tab
57 57
Worksheets in the Expected Survival Reports:Data_... Tab
58 58
Worksheets in the Expected Survival Reports:Beta_... Tab
59 59
Worksheets in the Expected Survival Reports:Bl_... Tab
60 60
Performing a Sub-Group Analysis Using the Expected Survival Reports
Sub-group analyses can show where a program is experiencing the difference between observed and expected outcomes.
Are deaths in high-risk patients driving the O/E difference?Are low quality donors driving the O/E difference?
The issue is not always in the group one first suspects.
Potential sub-group analyses aided by this tool:• DCD donor transplants vs. BDD donor transplants• Recipient age ranges• Donor age ranges• CIT• Surgeon or coordinator• Diabetic vs non-diabetic recipients• BMI
61 61
Performing a Sub-Group Analysis Using the Expected Survival Reports
62 62
Performing a Sub-Group Analysis Using the Expected Survival Reports
To ‘turn off’ or exclude a patient or group of patients delete ‘1’ in column A in the row for that transplant.
63 63
Performing a Sub-Group Analysis Using the Expected Survival Reports
The numbers at the top of the page will automatically be recalculated without these patients
64 64
Performing a Sub-Group Analysis Using the Expected Survival Reports
Step 1: Determine the characteristic, find the data and create groups.
Step 2: ‘Turn off’ or exclude all of the patients not in Group A.
Step 3: Record the observed and expected numbers for Group A.
Step 4: Turn all patients back ‘on’ by putting a 1 in first column.
Step 5: ‘Turn off’ or exclude all of the patients not in Group B.
Step 6: Record the observed and expected numbers for Group B.
Step 7+: Repeat steps for all sub-groups.
Compare the observed and expected numbers for the various groups.
65 65
Future Tools & Changes to Program Specific Reports
NLC 7 October 4-5, 2012 Transplant Track
Discussion and Questions
NLC 7 October 4-5, 2012 Transplant Track
Lean Mean Transplant Machine: Creating a Lean Culture
Linda Munro, RN, MSNTransplant InstituteHenry Ford Hospital
October 4th, 2012, 2:00 pm
NLC 7 October 4-5, 2012 Transplant Track
Outline
• Lean Culture• Lean Concepts• HFH Experience with Lean• Successes/Future Activities• References/Resources
NLC 7 October 4-5, 2012 Transplant Track
Henry Ford Hospital (HFH) Detroit, MI
NLC 7 October 4-5, 2012 Transplant Track
What is Lean Thinking?
• Lean – “doing more with less”
• Multiple complex processes to accomplish tasks and provide value to the patient
• Determine the value of any given process: Identify value added from non value added
steps Eliminate waste so that every step adds value
NLC 7 October 4-5, 2012 Transplant Track
Benefits of a Lean Culture
LEAN
Patient Safety
Patient Satisfaction
Employee Satisfaction
Quality of Care
NLC 7 October 4-5, 2012 Transplant Track
Key Concepts in Lean Thinking
• Culture- set of values and beliefs that are based on:
Continuous Improvement- seek to perfect the process
Process- a set of actions which must be accomplished in the proper sequence at the proper time to create value for the customer
Team- those at the top of the organization must lead it, but all who are involved must participate
NLC 7 October 4-5, 2012 Transplant Track
Lean Tools
• 5S - Sort, store, shine, standardize, sustain• Kanban – use of visual triggers to supply for
downstream demands• Standard Work-protocols, checklists• A3/PDCA- move from assessment and
planning to implementation• Value Stream Mapping (eliminate waste and
improve value)
HENRY FORD TRANSPLANT INSTITUTE – LEAN PROCESS IMPROVEMENT A3
Date: Project Name:
Team:
Problem Background/Description: PLAN
Hypothesis:
Current Condition:
Target Condition:
Problem Analysis:
Action Plan: DO
Results/Metrics: CHECK
Standardization/Sustain Change: ACT
NLC 7 October 4-5, 2012 Transplant Track
Evolution of Lean in the Transplant Institute
2009• Program Director adopted Lean philosophy as core concept• Began staff training but was sporadic 2011• .5 FTE position created to support Lean efforts in Transplant • Share the gain-report out at staff meeting
2012• All staff trained or refreshed in Lean • Became part of Performance Reviews
NLC 7 October 4-5, 2012 Transplant Track
Lean Projects
• PDCA/A3Improved Living Donor Follow-upReduced inactive patients on kidney waitlistSurgical Bundles to Prevent Complications
• Value Stream Mapping-Work flowImproved Referral to Listing TimeframeOR Flow to reduce potential for errors
NLC 7 October 4-5, 2012 Transplant Track
Future Activities
• “Defect boards” in all work areas • Empower staff to recognize problems and
“stopping the line” for patient safety events• Identify and develop Lean champions
across continuum of care in clinic and inpatient areas
• Visual Management-posting critical metrics• Develop a biannual 4 hour refresher class
NLC 7 October 4-5, 2012 Transplant Track
Key Points for Starting
• All stakeholders in process are Lean team members
• Share Lean knowledge with all involved• Identify and map the value streams• Promise that no one will lose their job • Must have some forward movement• Start small• Some projects can be done quickly
NLC 7 October 4-5, 2012 Transplant Track 80
In Closing
• Lean is a way of doing your daily work; looking for ways to reduce errors and waste and improving value, quality and safety to the patient
• It takes time to change the culture!!
• Managers must value Lean thinking and commit resources
• PDCA to sustain change
NLC 7 October 4-5, 2012 Transplant Track
References
• Graban, M. (2012). Lean Hospitals (2nd ed.). CRC Press, Boca Raton
• Going Lean in Health Care. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2005. (Available on www.IHI.org)
• Spear, S. & Bowen, H. K. (1999). Decoding the DNA of the Toyota Production System. Harvard Business Review.
• www.lean.org
NLC 7 October 4-5, 2012 Transplant Track
Contact Information
Linda Munro RN, MSNQuality and Regulatory Compliance ManagerTransplant Institute Henry Ford [email protected]
NLC 7 October 4-5, 2012 Transplant Track
How Can a Transplant Informatics Team Help Your
Process Improvement Efforts?
Sandra SchwantzOctober 4, 20122:00 – 4:00 p.m.
NLC 7 October 4-5, 2012 Transplant Track
What is a Transplant Informatics Team?
• Our Team• Roles and Responsibilities• Our Focus
NLC 7 October 4-5, 2012 Transplant Track
How Did We Begin Our Process Improvement Efforts?
• Reviewed the UNOS Candidate Listing• Reviewed the UNOS Registration and Follow-up
Forms• Reviewed information being requested by
regulatory agencies
NLC 7 October 4-5, 2012 Transplant Track
What Were Our Next Steps?
• Identified the phases of transplant
• Assessed each phase at an in-depth level
• Developed process improvement efforts at each phase where gaps were identified
NLC 7 October 4-5, 2012 Transplant Track
Pre-Transplant Phase Issues
• Ethnicity/Race and Citizenship“Social History” section of the clinical note
• Transplant Evaluation Informed Consent“Informed Consent” section of the clinical note
NLC 7 October 4-5, 2012 Transplant Track
Selection Conference and Listing Phase Issues
• UNOS Candidate Registration Formidentified 21 data points
• Selection Conference review and outcome
• Patient Notification Policy
NLC 7 October 4-5, 2012 Transplant Track
Transplant Phase Issues
• ABO verification process• UNOS Removal Policy• Cold ischemic time calculation
NLC 7 October 4-5, 2012 Transplant Track
Lessons LearnedFrom Having a Dedicated Informatics Team
• Provided an “outside” perspective• Improved documentation• Focus our educational efforts• Improved communication
NLC 7 October 4-5, 2012 Transplant Track
Ana M. Hands, MDNational Learning Congress
October 4, 2012
Monitoring with Dashboards and Homegrown QI Tools
Ochsner Health System
Multi-Organ Transplant Institute
NLC 7 October 4-5, 2012 Transplant Track
The Basics: What are Dashboards?
“Dashboards: Are easy to read collection of related reports used to monitor and provide a comprehensive picture of performance for a given variable, showing a graphical presentation of the current status and historical trends of Key Performance Indicators enabling instantaneous and informed decisions to be made at a glance.“
-Wikipedia
NLC 7 October 4-5, 2012 Transplant Track
Why Use Dashboards?
• Visual presentation of performance measures• Identify and correct negative trends• Measure efficiencies/inefficiencies• Align strategies and organizational goals• Save time compared to running multiple reports• Gain total visibility of overall performance instantly• Quick identification of data outliers and correlations
NLC 7 October 4-5, 2012 Transplant Track
A True Story…
NLC 7 October 4-5, 2012 Transplant Track
The Past: Our Problem
Jul 2005 Jan 2006 Jul 2006 Jan 2007 Jul 2007 Jan 2008 Jul 2008 Jan 2009 Jul 2009 Jan 2010 Jul 2010 Jan 2011 Jul 2011 Jan 2012 Jul 201270.0%
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
81.7%
80.3%
76.0%
73.9%
1-YR 3-YR
ADULT Single Organ Liver Transplant1-Year Patient Survival Published by SRTR
3-Yr National Average 78%
1-Yr National Average 86%
NLC 7 October 4-5, 2012 Transplant Track
The Facts
• Received letter from MSCP about metrics• Quality was questionable• Outcomes were dropping• Lack of accountability• Poor team engagement• Financial stability in jeopardy• Patient Satisfaction – Huh?
NLC 7 October 4-5, 2012 Transplant Track
How Do We Maximize Both?
NLC 7 October 4-5, 2012 Transplant Track
Transplant Council
CPRCompliance, Policy & Regulatory Committee
AbdominalCoordinator
PracticeCommittee
NursingTransplant
Council
Organ SpecificMorbidity & Mortality
Committees
Organ Specific Team Meetings
PatientSelection
Committee
Transplant Compliance
Manager
Heart TXCoordinator
PracticeCommittee
PerformanceImprovement
Dept.
StaffExecutiveCouncil
Nursing ExecutiveCouncil
PatientRelations
Action Plan: QA/PI
NLC 7 October 4-5, 2012 Transplant Track
QualityNo show
Rates
Referrals /Evaluations
Program Recognition
TreatmentCompliance
Outcomes
Listings
Patient Satisfaction
Employee Engagement
FinancialStability
Increased TX Volumes
Market Share
TXStandards
POTENTIAL IMPACT…
NLC 7 October 4-5, 2012 Transplant Track
• Developed monitoring tools• Multi-Disciplinary TEAM approach• Metrics Driven/Quality Focused• Well-informed decision making• Clear, strong leadership (MD/Admin)• Recruit and retain talent• Patient centered care• Transparency • Commitment & Accountability• Service, Innovation, Vision
Start With The Answer:Manage your results…Don’t let your results
manage you!
NLC 7 October 4-5, 2012 Transplant Track
Liver Performance DashboardStage
LIVER TRANSPLANT2012 DASHBOARD
2012 Goal
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov DecYTD
2012Actual 2011
Actual 2010
Monthly Referrals Received 50 56 61 72 61 250 641 434Median days from Referral to Financial Clearance
(domestic patients only)2 2 3 1 2 2 1 1
Median days Financial Clearance to 1st Appointment (domestic patients only)
14 17 23 18 14 18 25 18
Median days from Financial Clearance to Listing (domestic patients only)
60 56 55 96 79 77 74 62
Total Patients Listed in Month 17 12 19 21 16 68 204 1601 Year Death Rate on Waitlist 15.0% 16.9% 17.9% 18.6% 16.8% 18.6% 16.9% 14.5%
Monthly Transplant Volume 11 13 13 14 21 61 131 124Median Time (days) on Wait List for previous 12
months35 33 37 33 47 37 30
Median LOS in days 7 8 9 8 9 9 9 8% Re-Transplanted due to PNF 0% 0% 0% 0% 0% 0% 1% 0%% Re-Transplanted due to HAT 0% 0% 0% 0% 0% 0% 0% 3.5%
Median PRBC use during transplant (excludes multiple organs & re-txs)
3 3 5 3 5 4 3 3
Median PRBC use w/in 72 hrs post-tx (excludes multiple organs & re-txs)
0 1 1 0 1 1 0 0
Number of Organs Refused & Tx'd elsewhere 0 0 0 0 0 0 0 2Number of Organs Refused by Local Centers & Tx'd
here1 1 1 2 5 15 20
Number of Organs Imported / Total Done 3 / 13 8 / 13 8 / 14 13 / 21 48.8%# Living 13 13 14 21 61 124 119Tx Vol 13 13 14 21 61 130 124
% 100% 100% 100% 100% 100% 95% 96%Graft Survival % 100% 100% 100% 100% 100% 98%
# Pts 3 4 2 3 12 18 23Tx Vol 13 13 14 21 61 131 124
% 23% 31% 14% 14% 20% 14% 19%# Pts 1 0 0 2 3 3 7
Tx Vol 13 13 14 21 61 130 124% 8% 8% 0% 0% 10% 5% 2% 6%
# Pts 5 3 3 5 16 31 38Tx Vol 13 13 14 21 61 130 124
% 32% 38% 23% 21% 24% 26% 24% 31%Number of Infections Presented 10 6 6 5 27 3 48
Number of CMV Infections Presented 0 0 1 0 1 0 1% Non-Resident Aliens transplanted in most recent
12 monthsas of mo.
end< 5% 4.6% 4.4% 4.7% 4.6% 4.5% 5.4% 3.2%
Appointment No-Show Rate LIVER MEDICINE 5.0% 2.8% 6.1% 7.1% 8.4% 7.2% 6.3% 4.7%Appointment No-Show Rate TRANSPLANT
SURGERY6.5% 4.2% 2.5% 7.7% 7.9% 5.9% 5.8% 5.7%
rawscore
97.6 95.3 93.0 91.1 91.8 93.5 92.2
percentile rank
85 99 98 83 96 94 90 89
rawscore
82.8 88.9 89.4 88.2 86.1 88.1 89.1
percentile rank
85 78 81 88 86 83 82 93
n/a = not applicablen/a = data not available
Pre
Lis
t
Patient Survival as of report date
Tra
nsp
lan
t
Nat'lData
Below goal
Return to OR within 30 days of Transplant
Press Ganey TSU Patient Satisfaction Scores
Op
era
tio
na
l
98%
Po
st
Press Ganey Clinic Patient Satisfaction Scores(Abdominal Clinic only)
Hospital Readmission 0 - 30 days post tx-discharge
Above goalMeets
Hospital Readmission 0 - 2 days post tx-discharge
21%
Nat'lData
NLC 7 October 4-5, 2012 Transplant Track
StageLIVER TRANSPLANT2012 DASHBOARD
2012 Goal
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov DecYTD
2012Actual 2011
2011 Goal
Actual 2010
Monthly Referrals Received 50 56 61 72 61 79 74 75 47 525 641 38 434
Median days from Referral to Financial Clearance (domestic patients only)
1 3 5 3 3 1 3 3 1 3 1 2 1
Median days Financial Clearance to 1st Appointment (domestic patients only)
14 17 23 18 14 19 19 22 n/a 18 25 13 18
Median days from Financial Clearance to Listing (domestic patients only)
60 56 55 96 79 45 92 84 57 77 74 60 62
Total Patients Listed in Month 17 12 19 21 16 15 21 18 8 130 204 14 160
1 Year Death Rate on Waitlist 15.0% 16.9% 17.9% 18.6% 16.8% 16.0% 17.2% 19.8% 18.6% 18.6% 16.9% 15.0% 14.5%
PreLis
t
Liver Dashboard: Pre/ List
n/a = not applicablen/a = not available
Below goal Meets goal Above goal
NLC 7 October 4-5, 2012 Transplant Track
StageLIVER TRANSPLANT2012 DASHBOARD
2012 Goal
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov DecYTD
2012Actual 2011
2011 Goal
Actual 2010
Monthly Transplant Volume 11 13 13 14 21 18 17 17 10 123 131 11 124
Median Time (days) on Wait List for previous 12 months
35 33 37 33 37 44 43 42 47 37 30
Median LOS in days 7 8 9 8 9 12 12 8 10 9 9 7 8
% Re-Transplanted due to PNF 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0%
% Re-Transplanted due to HAT 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 3% 3.5%
Median PRBC use during transplant (excludes multiple organs & re-txs)
3 3 5 3 5 n/a n/a n/a n/a 4 3 3 3
Median PRBC use w/in 72 hrs post-tx (excludes multiple organs & re-txs)
0 1 1 0 1 n/a n/a n/a n/a 1 0 0 0
Number of Organs Refused & Tx'd elsewhere
0 0 0 0 0 2 2 0 1 5 0 0 2
Number of Organs Refused by Local Centers & Tx'd here
1 1 1 2 0 0 2 2 9 15 20
Number of Organs Imported / Total Done
3 / 13 8 / 13 8 / 14 13 / 21 12 / 18 3 / 17 10 / 17 3 / 10 48.8%
Tran
splan
t
n/a = not applicablen/a = not available
Below goal Meets goal Above goal
Liver Dashboard: Transplant
NLC 7 October 4-5, 2012 Transplant Track
StageLIVER TRANSPLANT2012 DASHBOARD
2012 Goal
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov DecYTD
2012Actual 2011
2011 Goal
# Living 13 13 14 21 17 16 17 10 121 124Tx Vol 13 13 14 21 18 17 17 10 123 130
% 100% 100% 100% 100% 94% 94% 100% 100% 98% 95%Graft Survival % 100% 100% 100% 100% 100% 100% 100% 100% 100% 98%
# Pts 3 4 2 3 3 3 2 20 18Tx Vol 13 13 14 21 18 17 17 10 123 131
% 23% 31% 14% 14% 17% 18% 12% 16% 14%# Pts 1 0 0 2 0 0 0 0 3 3
Tx Vol 13 13 14 21 18 17 17 10 123 130% 8% 8% 0% 0% 10% 0% 0% 0% 0% 2% 2% 8%
# Pts 5 3 3 5 6 3 5 1 31 31Tx Vol 13 13 14 21 18 17 17 10 123 130
% 32% 38% 23% 21% 24% 33% 18% 29% 10% 25% 24% 32%
Number of Infections Presented 10 6 6 5 6 5 5 4 47 3
Number of CMV Infections Presented 0 0 1 0 0 0 0 0 1 0% Non-Resident Aliens transplanted in
most recent 12 monthsas of mo.
end< 5% 4.6% 4.4% 4.7% 4.6% 4.9% 4.2% 4.0% 4.5% 4.5% 5.4% < 5%
Hospital Readmission 0 - 30 days post tx-discharge
Nat'lData
Nat'lData
Post
98% 98%
Return to OR within 30 days of Transplant
21% 21%
Hospital Readmission 0 - 2 days post tx-discharge
Patient Survival as of report date
Nat'lData
Nat'lData
Liver Dashboard: Post
n/a = not applicablen/a = not available
Below goal Meets goal Above goal
NLC 7 October 4-5, 2012 Transplant Track
StageLIVER TRANSPLANT2012 DASHBOARD
2012 Goal
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov DecYTD
2012Actual 2011
Appointment No-Show Rate LIVER MEDICINE
5.0% 2.8% 6.1% 7.1% 8.4% 9.6% 8.4% 7.6% 6.5% 7.2% 6.3%
Appointment No-Show Rate TRANSPLANT SURGERY
6.5% 4.2% 2.5% 7.7% 7.9% 4.7% 8.4% 5.0% 5.8% 5.9% 5.8%
rawscore
97.6 95.3 93.0 91.1 88.4 90.6 90.4 97.8 91.8 93.5
percentile rank
85 99 98 83 87 75 90 89 90 77 85
rawscore
82.8 88.9 89.4 88.2 78.1 95.6 83.9 86.8 86.1 88.1
percentile rank
85 7 81 88 76 1 99 16 51 33 78
Opera
tional
Press Ganey Clinic Patient Satisfaction Scores
(Abdominal Clinic only)
Press Ganey TSU Patient Satisfaction Scores
Liver Dashboard: Operational
n/a = not applicablen/a = not available
Below goal Meets goal Above goal
NLC 7 October 4-5, 2012 Transplant Track
Liver Compliance Dashboard
NLC 7 October 4-5, 2012 Transplant Track
The Present: Our Focus
Jul 2005 Jan 2006 Jul 2006 Jan 2007 Jul 2007 Jan 2008 Jul 2008 Jan 2009 Jul 2009 Jan 2010 Jul 2010 Jan 2011 Jul 2011 Jan 2012 Jul 201270.0%
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
81.7%
92.3%
76.0%
86.4%
ADULT Single Organ Liver TransplantPatient Survival Published by SRTR
1-YR 3-YR
1-Yr National Average 86%
3-Yr National Average 78%
NLC 7 October 4-5, 2012 Transplant Track
Architecture for SuccessQuality and Performance focus are
imperatives in the programmatic structure ofTransplant practice
Performance + Quality = Outcomes
NLC 7 October 4-5, 2012 Transplant Track
What We Need To Remember
• Tell you where you are- like a car!• It’s an actionable report• Not meant to be static but to change • Offer real time information• Help make informed decisions • Help change behavior• Patients have ONE shot at
this….same applies to us!
About Dashboards:
NLC 7 October 4-5, 2012 Transplant Track
• What will you do differently? • How will you engage your team?
What We Learned:Metrics have meaning
and measuring changes the behavior of those being measured”
- Youngme Moon, PhD.
NLC 7 October 4-5, 2012 Transplant Track
• We Know• We Own• We Change• We Make A Difference• We Don’t Stop….
“ If you can’t explain it simply,You don’t understand it enough” -Albert Einstein
If It's Not Here And Now, Who Cares About What And When?
NLC 7 October 4-5, 2012 Transplant Track
It’s All About Them…!
NLC 7 October 4-5, 2012 Transplant Track
Ana M. Hands, MDVice President
Multi-Organ Transplant InstituteOchsner Health SystemNew Orleans, [email protected]
504-842-6352
NLC 7 October 4-5, 2012 Transplant Track
Sample Dashboards
NLC 7 October 4-5, 2012 Transplant Track
StageKIDNEY, KIDNEY/PANCREAS, PANCREAS
2012 DASHBOARD2012Goal
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov DecYTD
2012Actual 2011
2011Goal
Actual 2010
Actual 2009
Monthly Referrals ReceivedMedian days from Referral to Financial Clearance
Median days Financial Clearance to 1st ApptMedian days from Financial Clearance to Listing
Total Patient Listed in MonthStatus 7 Percentage on Waitlist
1 Year Death Rate on WaitlistMonthly Transplant Patient Volume
Living Donor VolumeMedian Time (days) on Wait List for previous 12
months
KIMedian LOS in days - Cadaveric Standard Criteria
Donor RecipientsKI Median LOS in days - Living Donor RecipientsKI Median LOS in days - Living Donors
KIMedian LOS in days - Cadaveric Expanded Criteria
Donor RecipientsNumber of Organs Refused here & Tx'd elsewhere &
had Immediate/Delayed FunctionNumber of Organs Refused by Local Centers & Tx'd
HereNumber of Organs Imported / Total Done
# Func.Tx Vol
Patient Survival# Pts
Tx Vol%
# PtsTx Vol
% 5% 5%# Pts
Tx Vol% 28% 28%
# PtsTx Vol
% 21% 21%# Pts
Tx Vol% 35% 35%
KI Biopsy Rate within 1 Year of Transplant
(rolling 12 month period)
KI Rate of First Rejection Episode within 1 Year of
Transplant (rolling 12 month period)
KI Infection Rate within 1 Year of Transplant
(rolling 12 month period)
KI CMV Rate within 1 Year of Transplant
(rolling 12 month period) Appointment No-Show Rate KIDNEY MEDICINE
Appointment No-Show Rate TRANSPLANT SURGERYraw
scorepercentile
rankraw
scorepercentile
rankn/a = not applicablen/a = not available
Nat'lData
Nat'lData
Nat'lData
Nat'lData
Graft Survival (as of report date)
KI
KI
KI
CAD-KI
Nat'lData
Nat'lData
Nat'lData
%
Post-tx ATN non-Expanded (Standard) Criteria Donors
Pre
Tran
spla
nt
Po
stLi
st
KI,KP & PA
Hospital Readmission 0 - 2 days post tx-discharge (excludes KP & KI-LI)
Hospital Readmission 0 - 30 days post tx-discharge (excludes KP & KI-LI)
CAD-KI
KI Return to OR within 30 days of Transplant (excludes KP & KI-LI)
Op
era
tio
nal
Above goal
Post-tx ATN Expanded Criteria Donors
Press Ganey Clinic Patient Satisfaction Scores(Abdominal Clinic only)
Meets goalBelow goal
Nat'lData
Press Ganey TSU Patient Satisfaction Scores
NLC 7 October 4-5, 2012 Transplant Track
StageHEART TRANSPLANT
2012 DASHBOARD2012Goal
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov DecYTD
2012Actual2011
2011Goal
Actual2010
Monthly Transplant ReferralsNumber Presented at Selection
Median days from HLA/Evaluation to Presentation at Committee
First Clinic Visit to date of HLATotal Patients Listed in Month1 Year Death Rate on Waitlist
Transplant Volume VAD Volume
Advanced Surgical ProceduresStatus 1AStatus 1B
Median LOS in days (Without VAD)Median LOS in days (With VAD)
Median LOS in days (Other Circulatory Support)Median PRBC per transplant (excludes VADs,
mulitple organs, & re-transplants)Median PRBC use w/in 72 hrs post-tx (excludes
VADs, mulitple organs, & re-transplants)Median PRBC use per transplant
(VAD patients)Median PRBC use w/in 72 hrs post-tx
(VAD patients)# LivingTx Vol
%30 Day Re-Admissions (3 Months Post-Transplant)
90-Day Patient Survival for previous 12-month cohort
# Requiring Permanent Pacemaker# of Rejections Requiring Admission within 3 mos# of Infections Requiring Admission within 3 mos
Appointment No-Show Rate Heart Medicineraw
scorepercentile
rankraw
scorepercentile
rank
n/a = data not available
Ope
rati
onal
Li
stTr
ansp
lant
Post
Pre
Average Days @ status @ TX
Patient Survival as of report date
Above goalMeets goalBelow goal
Press Ganey Clinic Patient Satisfaction Scores
Press Ganey TSU Patient Satisfaction Scores
NLC 7 October 4-5, 2012 Transplant Track
StageLUNG TRANSPLANT2012 DASHBOARD
2012 Goal
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec YTD 20122011 Goal
Actual 2011
Actual 2010
Monthly Referrals/Inquiries ReceivedMedian days from Referral to Financial Clearance
Median days Financial Clearance to 1st AppointmentNumber Presented at Selection Committee
Number of Pre-LUT EvaluationsNumber of Clinic Visits
Median days from 1st Appointment to ListingMedian days from Financial Clearance to Listing
Total Patients Listed in Month
Transplant VolumeMedian ICU LOS
Median Hospital LOSMedian Days on Vent
30-Day Patient Survival90-Day Patient Survival
# PtsTx Vol
%# Pts
Tx Vol% 8% 8%
# PtsTx Vol
% 32% #DIV/0! 32%Nosocomial Infectons
CMV InfectionsOther InfectionsAcute Rejection
Chronic RejectionAirway Complications Requiring Intervention
Re-IntubationsMalignancy
Pleural Space DiseaseThromboembolic Disease
Other CV ComplicationsAppointment No-Show Rate LUNG MEDICINEAppointment No-Show Rate LUNG SURGERY
rawscore
percentile rankraw
scorepercentile
rank
Tran
spla
ntO
pera
tiona
l Press Ganey Clinic Patient Satisfaction Scores(Lung Clinic only)
Hospital Readmissions 0 - 2 days post tx-discharge
Press Ganey TSU Patient Satisfaction Scores
Nat'l Data
Nat'l DataHospital Readmissions 0 - 30 days post tx-discharge
Above goalMeets goalBelow goal
Pre
List
Post
Nat'l Data
Nat'l Data
Return to OR within 30 days of Transplant
NLC 7 October 4-5, 2012 Transplant Track
20-Junethru
26-June
27-Junethru
3-July
4-Julythru
10-July
11-Julythru
17-July
18-Julythru
24-July
25-Julythru
31-July
1-Augthru
7-Aug
8-Augthru
14-Aug
15-Augthru
21-Aug
22-Augthru
28-Aug
Referrals 12 12 23 18 22 10 11 14 6 11 8
Listings 4 4 6 1 9 3 4 3 3 0 2
Transplants 3 5 6 4 2 3 5 2 3 4 1
Number Financially Cleared - 20 15 18 26 8 11 10 6 7 5
Delistings - 1 0 0 0 1 1 0 0 0 0
Liver Medicine No-Show Rate(week before selection)
5.00% 17.02% 9.86% 25.00% 3.23% 6.06% 3.85% 6.25% 0.00% 11.43% 0.00%
International Transplant Rate(as of day before selection)
< 5% 4.22% 4.17% 4.12% 4.09% 4.05% 4.00% 3.98% 3.98% 3.93% 4.47%
# of Active Listed Patients(as of day before selection)
- 107 107 105 111 111 110 110 109 106 106
# of Inactive Listed Patients(as of day before selection)
- 4 4 4 4 4 4 4 4 4 4
Total # of Patients In Work Up(as of day before selection)
- 128 134 135 120 122 120 128 123 128 134
Goal
Weekly Liver DashboardAugust 21, 2012
Week of:
NLC 7 October 4-5, 2012 Transplant Track
Discussion and Questions