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


Speakers

Pam Gillette, MPH, RN, FACHEMedical City Dallas

Ajay Israni, MD, MSSRTR

Linda Munro, RN, MSNHenry Ford Hospital

Sandra Shwantz, MPTMayo Clinic Rochester


Surviving the Rough Waters of an SIA

Pam Gillette, MPH, RN, FACHEVice President, Transplant ServicesMedical City Dallas


What is an SIA?

• Systems Improvement Agreement• Alternative step to decertification • Agreement between Transplant Hospital and

CMS• Triggers for SIA


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


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


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


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


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


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


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


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


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!


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


OPTN Data cut for draft release.–Data current up to this day.

23 23


Data cleaned and prepared. Reports created.

24 24


Draft Reports and Missing Data Sheets are posted to the SRTR Secure Site. -Observed results only.

25 25


30-Day Data Review Period.

-All data changes will be reflected in the final report.

26 26


OPTN Data cut for final release.–All changes made by this date will be included.

27 27


Data cleaned and prepared. Final reports created.

28 28


Secure Release andComment period begin. Reports and Expected survival worksheets are posted to the SRTR Secure Site.

29 29


Comment period allows centers to add text that will be appended to reports.

30 30


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


A ‘1’ indicates this graft counted as a failure for this timeframe.

40 40


41 41


Initial white columns: Items with ‘1’ flagged for review

42 42


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


55 55


56 56


57 57


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


62 62


To ‘turn off’ or exclude a patient or group of patients delete ‘1’ in column A in the row for that transplant.

63 63


The numbers at the top of the page will automatically be recalculated without these patients

64 64


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

66

Questions?1-877-970-SRTR

[email protected]


Discussion and Questions


Lean Mean Transplant Machine: Creating a Lean Culture

Linda Munro, RN, MSNTransplant InstituteHenry Ford Hospital

October 4th, 2012, 2:00 pm


Outline

• Lean Culture• Lean Concepts• HFH Experience with Lean• Successes/Future Activities• References/Resources


Henry Ford Hospital (HFH) Detroit, MI


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


Benefits of a Lean Culture

LEAN

Patient Safety

Patient Satisfaction

Employee Satisfaction

Quality of Care


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


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


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


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


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


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


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

http://www.ihi.org/

http://www.lean.org/


Contact Information

Linda Munro RN, MSNQuality and Regulatory Compliance ManagerTransplant Institute Henry Ford [email protected]

mailto:[email protected]


How Can a Transplant Informatics Team Help Your

Process Improvement Efforts?

Sandra SchwantzOctober 4, 20122:00 – 4:00 p.m.


What is a Transplant Informatics Team?

• Our Team• Roles and Responsibilities• Our Focus


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


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


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


Selection Conference and Listing Phase Issues

• UNOS Candidate Registration Formidentified 21 data points

• Selection Conference review and outcome

• Patient Notification Policy


Transplant Phase Issues

• ABO verification process• UNOS Removal Policy• Cold ischemic time calculation


Lessons LearnedFrom Having a Dedicated Informatics Team

• Provided an “outside” perspective• Improved documentation• Focus our educational efforts• Improved communication


Ana M. Hands, MDNational Learning Congress

October 4, 2012

Monitoring with Dashboards and Homegrown QI Tools

Ochsner Health System

Multi-Organ Transplant Institute


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


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


A True Story…


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%



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?


How Do We Maximize Both?


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


QualityNo show

Rates

Referrals /Evaluations

Program Recognition

TreatmentCompliance

Outcomes

Listings

Patient Satisfaction

Employee Engagement

FinancialStability

Increased TX Volumes

Market Share

TXStandards

POTENTIAL IMPACT…


• 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!


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


21%

Nat'lData


StageLIVER TRANSPLANT2012 DASHBOARD

2012 Goal


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



2012 Goal


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



Liver Dashboard: Transplant



2012 Goal


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%


Nat'lData

Nat'lData

Post

98% 98%


21% 21%



Nat'lData

Nat'lData

Liver Dashboard: Post





2012 Goal


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)


Liver Dashboard: Operational




Liver Compliance Dashboard


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




Architecture for SuccessQuality and Performance focus are

imperatives in the programmatic structure ofTransplant practice

Performance + Quality = Outcomes


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:


• 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.


• 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?


It’s All About Them…!


Ana M. Hands, MDVice President

Multi-Organ Transplant InstituteOchsner Health SystemNew Orleans, [email protected]

504-842-6352


Sample Dashboards


StageKIDNEY, KIDNEY/PANCREAS, PANCREAS

2012 DASHBOARD2012Goal


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



StageHEART TRANSPLANT

2012 DASHBOARD2012Goal


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


Above goalMeets goalBelow goal

Press Ganey Clinic Patient Satisfaction Scores



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


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



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:


Discussion and Questions

NLC 7 October 4-5, 2012 Transplant Track Performance Improvement and Risk Mitigation in...

Documents

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