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					    Collaborative Success
Memorial University Medical Center
                &
       LifeLink of Georgia

                Staci Ravita
      Hospital Development Specialist
            LifeLink of Georgia
Collaborative Initiative

                    The problem
   Nearly 100,000 people in the nation are currently
    waiting for an organ.
   2,200 Georgians are listed.
   Approximately 17 people on the transplant waiting
    list die each day.
   Collaborative goal achievement saves thousands
    of additional lives.
Collaborative Initiative

                      Goal
“Together we are committed to saving or enhancing
thousands of lives a year by spreading known best
practices to the nation’s largest hospitals to achieve
organ donation rates of 75% or higher in these
hospitals.”
Collaborative Aim
      Maximize organ donation in the hospital
     by converting more potential organ donors
              to actual organ donors.
                     Objectives
     Increase the conversion rate to 75%
     Encourage 100% timely referral notification
     Achieve 100% organ referral rate on
      consistent basis
     Review 100% of vented death medical records
     Increase appropriate requestor rate to 75%
Strategies for Early Referral &
Effective Requesting

   In-House Coordinator
   Liaison Visibility on Day, Night and
    Weekend Shifts
   New Nurse Orientation
   Team Huddles
   Physician Education
   Quarterly Critical Care In-services
   Clinical Trigger Badges
Strategies for Physician Education

   Resident Education
    •   Trauma
    •   Surgery
    •   Pediatrics
    •   Internal Medicine
   Internal Medicine Grand Rounds
   Ethics Grand Rounds
   Informal visits on unit
   After Action Reviews
Strategies for Performance Improvement

   Timely Referral Follow-up
   Informal After Action Reviews
   Monthly Referral Rate Report and Dashboard
   Monthly Medical Record Review
   Bi-Monthly Donation Committee Meetings
Strategies for Donation Committee

   Review Referral Rate Report and Dashboard
   Review Eligible Referrals
    (Include Donors and Non-Donors)
   Review Late Imminent Referrals
   Review Missed Brain-Dead Patients (if any)
   Discuss Upcoming Educational Opportunities
Memorial University Medical Center
Organ Donors 1997 - 2007

  35
  30

  25
  20
  15

  10

   5
   0
       1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Memorial University Medical Center
Tissue Donors 1997 - 2007

  16
  14
  12
  10
   8
   6
   4
   2
   0
       1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Memorial University Medical Center
Conversion Rate 1997- 2007

 100%
  90%
  80%
  70%
  60%
  50%
  40%
  30%
  20%
  10%
   0%
        CY1997
                 CY1998
                          CY1999
                                   CY2000
                                            CY2001
                                                     CY2002
                                                              CY2003
                                                                       CY2004
                                                                                CY2005
                                                                                         CY2006
                                                                                                  CY2007
It Really is All About the 1’s

   1 Donor honored at a time
   1 Donor family’s wishes honored at a time
   1 Life saved at a time
   1 Month at a time
   …and each 1 of you…

    “…a human issue with human impact…”
  Hospital Development
 “Effective Collaboration”

          Tynetta Truesdale
       Transplant Coordinator
California Transplant Donor Network
OPO’s in California
                   Our Team
• Clinical Coordinators
  –   Resource Coordinator
  –   Transplant Coordinators
  –   Advanced Practice Coordinators
  –   Placement Coordinators
  –   Recovery Team
• Family Resource Coordinators
• Hospital Development
   – Donation Services Liaisons
• Community Outreach
        Internal Clinical Rounds
 Hospitals (including Coroner’s/Medical Examiner)
    Hospital Development
        Relationship Building
        Referral Process
    Education
    Brain Death Declarations
    Donation After Cardiac Donation (DCD) evaluation

 Families
      Brain Death Declaration Plan
      Family Care
      Donation Discussions
      Family Follow up
 Recipients
    Serology and HLA’s
    Optimize the gift through effective donor management
          Hospital Highlight

• Stanford University Medical Center
  – Teaching Facility
  – Transplant Center
  – Beds
    • Critical Care Beds 67
    • Total Beds 606
Stanford University Medical Center

• Pre-Collaborative:
     •   Hospital Relationship
     •   Hospital Communication
     •   Referral Process
     •   Family Support
     •   Donor Management
Activity Pre and Post Collaborative

Activity Dashboard              2002   2003   2004   2005   2006   2007



Total Number of Donors/DCD
Donors                             8      5     13   13/1     11   13/1


Conversion Rate                 61%    55%    72%    72%    85%    81%




Referral Compliance             97%    96%    97%    96%    98%    99%


Organs per Donor                   5    4.2    4.3    3.6    4.2    3.7




Number of Organs Transplanted     40     21     56     48     40     49
Stanford University Medical Center

 Post Collaborative
    Improvements
       Hospital Communication
         Management invites to Collaborative
         Appropriate and timely referrals
         Preliminary mention
       Hospital Relationships
         Donor Council
         Rounds
         Death record reviews with Physicians
       Referral Process
         Clinical Cues
         Case Debriefs
       Family Support
       Donor Management
         Clinical Support (APC)
         Meeting Donor Management Goals
Activity Pre and Post Collaborative

Activity Dashboard              2002   2003   2004   2005   2006   2007



Total Number of Donors/DCD
Donors                             8      5     13   13/1     11   13/1


Conversion Rate                 61%    55%    72%    72%    85%    81%




Referral Compliance             97%    96%    97%    96%    98%    99%


Organs per Donor                   5    4.2    4.3    3.6    4.2    3.7




Number of Organs Transplanted     40     21     56     48     40     49
Questions
Enhancing the potential for
        success!


 “There is no limit to what we can
 accomplish if it doesn’t matter who
           gets the credit.”

                       Author Unknown
We believe that life
 is a gift to share

    Kathy Selden, RN
   LifeSource Hospital Liaison
       September 17, 2008
At the end of this program participants will be able to;

• recognize the benefits of real time customer service

• apply the use of data to increase motivation for
  improvements

• create collaborative relationships with senior leaders
           LifeSource Service Area
                      Grand Forks   •

                                                Duluth
                                                   •
               Bismarck •       Fargo   •


                                            Twin
                                            Cities •
                                            Rochester •
Rapid City •
                            Sioux Falls •
Hospital Development Model
   • Chief Executive Officer
   • Director of Tissue Services and Hospital Services
   • Hospital Services Managers
   • Hospital Liaisons
      –   St. Paul
      –   Duluth
      –   Rochester
      –   Fargo
      –   Grand Forks
      –   Bismarck
      –   Sioux Falls
      –   Rapid City

   • Education Coordinator
   • Funeral Director/Medical Examiner Liaison
First Things First……………
• Collaborative Building Blocks for Success

• Best Practices

• High Leverage Changes
Real Time Customer Service
  • High visibility

  • Increased continuity

  • One on one interactions with staff

  • Immediate review of the process

  • Fosters collaboration/promotes best practices

Hospital Coordinator
                                               Hospital Dashboard
                                                                        ORGAN DONATION




                                                                                                        2007 2008
                                                                         2007    2008                   DCD DCD 2007     2008
                                                2007 Auth. 2008 Auth.    Conv.   Conv.   2007 2008     Donor Donor Organ Organ
               Account Name                        Rate       Rate       Rate    Rate    OTPD OTPD       %    % Donors Donors

Children's Hospitals and Clinics-Minneapolis      100%       100%        100%    100%    3.67   5.00    0%    0%     3     1

Children's Hospitals and Clinics-Saint Paul        67%       100%         67%    100%    3.00   4.00    0%    0%     2     1

Regions Hospital                                   75%        75%         67%    80%     4.38   4.00    0%   25%     8     4
Saint Cloud Hospital                               75%       67%          80%    67%     2.25   1.00    0%   0%      8     2
                Champions
Relationships at the “C” level
   • CEO relationships


LifeSource Critical Care Committee
   •   Critical Care Physicians
   •   Review processes/management strategies
   •   Analyze data on outcomes
   •   Case reviews
   •   Opportunity to affect change
Conversion Outcome Reviews (CORs)
• All approaches
• Hospital development and procurement staff


Improvement Opportunities to Date
   – Early physician connection
   – Team huddles
   – Ongoing assessment for DCD
African-American Outreach

      Community Initiatives

 “Only You Have the Power to Save Lives”

      “Barbershop Conversations:
       Clean Cut and To the Point”
 Hospital Development



Level One Trauma Center
  Models for Success


    Monica James RN BSN CPTC
      Transplant Coordinator
 New York Organ Donor Network’s
          Service Area
‫٭‬New York City
     (Bronx, Brooklyn, Manhattan, Queens, Staten Island)
‫٭‬Long Island
‫ 5 ٭‬Hudson Valley counties in New York State
     (Rockland, Putnam, Orange, Westchester & Dutchess)

‫ 1٭‬county in Pennsylvania (Pike County)
‫ 31٭‬million population

‫ 601٭‬hospitals
‫ 9٭‬transplant centers
          BACKGROUND

• Donation Rates were low when
  compared to national average
• Need to put systems in place to address
  the low Consent and Referral Rates in
  our high potential hospitals
• Create a model for success that can be
  duplicated in other area hospitals
  In-House Transplant Coordinator
• Donation/Transplant Coordinator with the OPO
  expertise to:
   – Early support potential organ donor families
   – Present the opportunity for Gifts of Life to potential
     organ/tissue donor families
   – Initiate & Provide
      • Education to hospital staff on donation process
         – Early Referral
         – Early Donor Management
• Resource to hospital Staff on All aspects of donation
  i.e. Organ Recovery, DCD, CoP
     Jacobi Medical Center Profile

• Level one Trauma Center
  – Largest Public Hospital in Bronx
  – Second largest Burn Center in NYC
• Number of beds: 340+
• Critical care areas: 7
• Affiliations: Albert Einstein College of Medicine
Westchester Medical Center Profile


• One of the largest Level I Trauma Centers
    – Servicing the residents of Southern New York,
      Northern New Jersey, and Southern Connecticut.
•   Number of beds: 600+
•   Critical care areas: 13
•   Affiliations: New York Medical College
•   Transplant Center
    – Kidney, Liver, Heart
                  Objectives

• Improve OPO and Hospital relationship

• Increase Consent Rate & OTPD
   – Assess how the evolution of organ donation
     has affected the hospital staff.

  – Identify stressors to the multidisciplinary
    teams involved- Hospital staff, OPO team,
    others

  – Formulate strategies to manage and
    improve morale for all involved parties
What is the Changing Donor
Environment?
• Early Referral/ Rapid Linkage

• Expanded Criteria Donors
  – Increased co- morbidity
     • Hypertension, elevated creatinine >2.0, h/o CVA
  – Increased age (>60 yr.)

• Donation after Cardiac Death Donors
  – GCS < 5
  – Devastating spinal injury with maintained
    consciousness
  – Any ventilated patient with plan for palliative
    shift off or deceleration of artificial support
Jacobi Organ Consent Rate 2000 - 2007

                                           Organ         Consent
                                        Referral Rate     Rate
  8
                                         2000: 85%      2000: 35%
                                         2001: 94%      2001: 40%
           14
                11                       2002: 95%      2002: 61%
       6              9             13
 15                        7   13        2003: 100%     2003: 58%
                                         2004: 100%     2004: 53%
       9    8                            2005: 100%     2005: 50%
                 8    8    7         7
  4                             5                       2006: 72%
       1    1                            2006: 100%
                                                        2007: 72%
2000 2001 2002 2003 2004 2005 2006 2007  2007: 100%

 Not Referred     No Consent          Donor


                      New York Organ Donor Network
                 Westchester Medical Center
                  Consent Rate 2000-2007

                                                     Referral Rate   Consent Rate
                                                     2000: 72%       2000: 52%
      16           23                                2001: 89%       2001: 47%
11                             17    31     31       2002: 95%       2002: 60%
                          16
            12                                       2003: 84%       2003: 67%
10    16           12
                               12                    2004: 93%       2004: 68%
            9             10
                                      9              2005: 88%       2005: 64%
 8                 6                        8
       4    1              2    4                    2006: 100%      2006: 80%
2000 2001 2002 2003 2004 2005 2006 2007              2007:100%       2007: 81%

     Missed Ref.        No Consent    Donor


                               New York Organ Donor Network
      JMC2006 HRSA Comparison
      Organs Transplanted per Donor


  4           3.75 National Goal
3.5
  3                                               Jacobi Medical Center
2.5
                                                  National (2006)
  2
1.5                                               NYODN Region
          2.85           2.77            2.56
  1                                               National Goal
0.5
  0
           2006 Organs Transplanted per Donor




                   New York Organ Donor Network
      JMC 2007 HRSA Comparison
      Organs Transplanted per Donor


  4           3.75 National Goal
3.5
  3                                               Jacobi Medical Center
2.5
                                                  National (2007)
  2
1.5                                               NYODN Region
          2.69           2.77            2.44
  1                                               National Goal
0.5
  0
           2007 Organs Transplanted per Donor




                   New York Organ Donor Network
      WMC 2006 HRSA Comparison
      Organs Transplanted per Donor


  4          3.75 National Goal
3.5
  3                                                Westchester Medical Center
2.5
                                                   National (2006)
  2
1.5                                                NYODN Region
          2.81          2.77         2.56
  1                                                National Goal
0.5
  0
         2006 Organs Transplanted per Donor




                    New York Organ Donor Network
       WMC 2007 HRSA Comparison
       Organs Transplanted per Donor


4.00          3.75 National Goal
3.50
3.00                                                   Westchester Medical Center
2.50
                                                       National (2007)
2.00      3.70
1.50                   3.00                            NYODN Region
                                     2.44              National Goal
1.00
0.50
0.00
         2007 Organs Transplanted per Donor




                        New York Organ Donor Network
  WOW- Look at the record books…

• Oldest lung donor 65 year old (NYODN)
• 2007 Westchester Medical Center 7 Lung Donors

• 2007 HRSA Medal of Honor Recipients
   – Jacobi Medical Center
   – Westchester Medical Center

• Westchester Medical Center
 #1 Gifts of Life Donor Hospital for the last 4 years
          Positive Outcomes!

• Sustained increase in Referral Rate
  – Early Referral Rapid Linkage
• OPO seen as a vital resource to hospital
  culture in providing patient services:
  – included in Donation Policy Revisions
  – Implementation of Donor Management
    Guidelines
  – Included in employee orientation process
• Hospital Staff Buy-In for Dual Advocacy
              Ideas to Create an Effective
               Collaborative Relationship
• Think WIN: WIN not US
• Think HOPE: Hospital, OPO, Perseverance in Family Support,
  Envision Lives Saved

• Know Organ Donor process
   – policies on withdrawal of care and DCD.
   – Seek hospital resources when needed. Don’t wait.

• Establish separate ongoing education for ICU units (RN, MD,
  NP, PA, Nursing leadership)
   – Include recipient and donor families speakers.

• Create forum which meets to discuss issues surrounding organ
  donation
   – Quarterly Donor Council Meeting, Nursing Leadership Mtg.
   – i.e. policies, QA/QI
   – Multidisciplinary involvement
             Ideas to Create an Effective
              Collaborative Relationship

• Multidisciplinary Involvement
   –    Senior Hospital Leadership
   –    QA/PI
   –    Public Relations
   –    Chief Resident Committee
   –    Psych. Nurse
   –    Chaplaincy
   –    Nuclear Medicine
   –    Cardiac Cath. Lab
   –    Social Work
   –    Respiratory
   –    Security
       The Donation Process Happens on all Levels & Departments
                of a Medical Center, Don’t Take Short Cuts…

				
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