Session #2: The Evolution of Donation Process and

Planning

Doug Miller 2013

Connect to Purpose“Dear Medical staff, I would like to thank all of you for the care you gave to my donor and their family members. I believe the care you provided allowed for my successful transplant. …. I work in a military hospital serving active duty military, their families, and veterans. This is a job I have always loved and because of your efforts, I will be able to continue to do so. I have found that there is no greater gift in the healthcare field than being able to provide services for those in need as I’m sure you all well know. I just want to remind you that the work you do is vital and so important. It is most appreciated and I ask that you all please continue being the best care givers that I know you are. Again, I send you all (nurses, social workers, doctors, surgeons, aids and any other staff) a heartfelt thanks for taking care of my donor and the needs of the family.”

Today’s Discussion: Evolution

1. Planning for Donation

2. Donation in Process

Donation Planning: Current State

• Regulations require OPOs work with hospitals and specify pieces of information that must be shared– Hospital development (HD) plans/yearly

organ donation assessment (YODA)/hospital profile

• Completed annually

• Different requirements depending on size/volume of hospital

• Auditable

Yearly Organ Donation Assessment (YODA)

Hospital Development Plan

Switching Gears

Donation Planning Evolved: Forward

Focus Hospital Teams

• Yearly Assessment: Pre-Work– Value stream mapped donation process

• HD Plan: PDSA– Mutually defined problem statement,

created goals, piloted actions, measured improvement

Overview of Key Steps

1. Supportive Family Care and Donor

Management

Pre-Work Instructions• For each of the 11 key steps, fill in the current way these

steps happen at your hospital with the WHO, WHAT and HOW

• Hooray or headache? Reflect if this is a part of the process that works really well currently (hooray!) or needs some improvement (headache)

• You may complete this part by either directly observing an actual donor case or reflecting on previous donor cases

• Also consider how the process steps may vary if it’s a brain dead (DBD) versus cardiac dead (DCD) donor

Step 2: Referral

WHO? ICU Nurse (typically)HUC (sometimes delegated to if busy)

WHAT? Makes the initial call to UW OTD

HOW? Identifies patient met clinical triggersCalls StatlineProvides information from chartCreate plan for follow-up communication with UW OTD

Hooray or Headache?

Hooray - works well

What’s happening? Patient meets criteria for a referral to UW OTD

PDSA

Only-Child Mentality: So, how does this effect my life?

What is a Potential Donor?

What Is The True Denominator for Potential Organ Donation?

Eligible Deaths

Other Potential Donors Not Declared Brain Dead

Other Potential Donors(DCD, > age 70, etc.)

•Medically suitable (to the best of our knowledge – ex: serologies)

•Within our normal practice to pursue either DBD or DCD donation

Potential Donor Data for Next Hospital Cohort

DSA Metrics and Outcomes

DSA HospitalsTrue Donor Potential

True Conversion

Rate (Goal=90%)

OrgansTransplanted

Per Donor (Goal 3.45)

Forward Focus Team Hospitals

332 61% 3.03

Hospital A 24 42% 3.30

Hospital B 18 44% 3.00

Hospital C 17 59% 2.50

Hospital D 17 35% 3.17

Hospital E 15 60% 2.78

Hospital F 11 45% 3.80

Hospital G 7 43% 3.00

Hospital H 7 71% 2.20

Hospital I 6 33% 2.50

Hospital J 6 67% 3.75

Other Hospitals 26 46% 2.83

Entire DSA 486 57% 3.01

Date Range: 01/01/2011-03/31/2013

How Do We Start?

Donation Planning: Priming the Pump

• Expect a different assessment model and planning tools to be used in 2013– Emphasis on more thorough assessment;

consider multi-disciplinary group– No more than 1-2 defined projects; emphasis

on improving consent rate • Assessments and plans need to be completed

and signed by July 1, 2013

Donation in Process: Best Practices from Forward Focus

• Forward Focus has demonstrated best practices over the last 18 months• Collecting potential donor data, real-time

huddles, after action review of potential donors (not just actual)

• Process is evolving from pilot testing at original 9 Forward Focus teams

Group Discussion• What excites you most about this

transition?

• What is something you can do by next Tuesday to help get ready for this transition?

Volunteer to Report out to Plenary?