NLC 7 Transplant Track
Optimizing Patient and Family
Centered Care
Friday, October 5, 2012
NLC 7 October 4-5, 2012 Transplant Track
Transplant Center Growth and
Management Best Practices
1. Institutional Vision and Commitment
2. Dedicated Team
3. Aggressive Clinical Style
4. Patient and “Family” Centered Care
5. Financial Intelligence
6. Aggressive Management of Performance
Outcomes
NLC 7 October 4-5, 2012 Transplant Track
Optimizing Patient and Family
Centered Care
• Bring Patients and Staff Together – Linda Munro
• Patient and Family Advocacy Council – Patty
Geerdes
• Effective Change Management – Katie McKee
NLC 7 October 4-5, 2012 Transplant Track
Henry Ford Transplant Institute
Detroit, Michigan
Bringing Patients and Staff Together:
Patient Centered Care Committee
Linda Munro, RN, MSN
Manager-Quality and Regulatory Compliance
Elizabeth Rubinstein
TLC Volunteer Coordinator
October 5, 2012 9:30 am
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NLC 7 October 4-5, 2012 Transplant Track
Patient Centered Care
• IOM 2001 Health Care System Mandate
– Respect patient’s values, preferences and needs
– Coordinate/integrate care beyond system boundaries
– Provide information, communication, education that
people need and request
– Guarantee physical comfort, emotional support, and
involvement of family and friends
NLC 7 October 4-5, 2012 Transplant Track
Patient Centered Care Evolution
• Incorporate patient/family perspectives into
organizational policies
• Incorporate patient/family perspectives into quality
improvement initiatives
• Innovations that improve patient satisfaction while
reducing waste and cost
• Sourcing of reliable patient/family feedback
• Sustaining patient/family partnerships
NLC 7 October 4-5, 2012 Transplant Track
Establishing Henry Ford
Patient Centered Care Committee
• Incorporation of Successful Patient Initiative
- Transplant Living Community (TLC) established 2008
- On site volunteer mentorship program
- Framework for engaging patients/families in total
transplant experience from pre to post
- Educational support and tools for transplant success
- TLC “ACES” platform to compliment medical goals
- Training Curriculum: HIPAA, patient safety, lifestyle versus
medical, patient referral, empathic listening skills
NLC 7 October 4-5, 2012 Transplant Track
Establishing Henry Ford
Patient Centered Care Committee
• TLC Program Prime Candidate for PCCC Linkage
– Favorable feedback from patients/families on TLC mentorship,
PHR hardcopy tools, healthy living platform
– Ability to collect real time patient feedback consistently both
in clinic and bedside
– Ability to conduct random pulse point/process surveys
– Able to provide volume patient experience reporting
– Provided services to compliment/reinforce medical staff goals
– Established transplant team member
– TLC life style education kits GOLF grant funded
NLC 7 October 4-5, 2012 Transplant Track
Henry Ford
Patient Centered Care Committee
• Committee Established January 2010
• Membership
– Designated physician chairperson
– Representatives across all discipline/clinical areas
– Transplant administration representatives
– TLC Ambassador volunteers
– Open invitation to patients, families, caregivers
NLC 7 October 4-5, 2012 Transplant Track
Henry Ford
Patient Centered Care Committee
• Rules of Conduct
– Show up and choose to be present
– Pay attention to what has heart and meaning
– Speak truthfully without blame or judgment
– Be open to change and innovation
– Patient safety and respect are foremost
– Engagement aligned from both healthcare
members and patient perspectives
NLC 7 October 4-5, 2012 Transplant Track
Engage, Empower, Improve
• Educational component to each meeting
• Structured agenda to give voice to all
• Actions driven with 3 tier integrated approach
– Treatment Plan, Care Pathway, Patient Goals
– Quality and patient safety priorities
– Patient compliance/ownership emphasis
• Consistent education platform through out continuum
• Improvement initiatives instilled in care culture
• Collaborative responsibility for success
NLC 7 October 4-5, 2012 Transplant Track
PCCC Accomplishments
• Kidney/Liver patient education handbooks
• Patient responsibilities as care team partners
– Inpatient kidney/liver goals immediate post transplant
• Lifestyle discharge curriculum to compliment
medical
• Staff satisfaction/trust with TLC Ambassador care
team partners
NLC 7 October 4-5, 2012 Transplant Track
PCCC Accomplishments
• Tools for patient home charting
• PHR hardcopy tools and education
• Transplant class curriculum for caregivers and
patients
• Laboratory services survey for patient wait times
• Higher patient satisfaction equaling higher scores
NLC 7 October 4-5, 2012 Transplant Track
PCCC Next Steps
• Quality (LEAN) initiative to address laboratory wait time
• PHR hardcopy conversion to electronic applications
– “My Chart” super user TLC mentors
•
•
•
•
Commencement of IRB approved TLC research
Patient transition focus in all care phases
Continued empowerment of patient health ownership
Living donor healthy pathways TLC/PCCC mentorship
NLC 7 October 4-5, 2012 Transplant Track
The Henry Ford Experience:
Listening From All Directions
“Patients have power to make choices that will have a
positive impact on their body, mind, and spirit. Patients
choose to discover ways to live their best lifestyle yet
and live it in ways that are truly healthy, smart, and
inspired. The Patient Centered Care Committee and TLC
can help guide individuals in this process.”
1985 Heart Transplant Recipient and TLC Ambassador
NLC 7 October 4-5, 2012 Transplant Track
Henry Ford Transplant Institute
THANK YOU
For Further Information Contact:
Linda Munro, RN, MSN
Elizabeth Rubinstein
LMUNRO1@hfhs.org
ERUBINS1@hfhs.org
NLC 7 October 4-5, 2012 Transplant Track
The Importance of
Change Management
in Optimizing Patient & Family
Centered Care
Katie McKee
National Learning Congress
October 5, 2012 9:30 a.m.
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Implemented Patient Online
Services to:
• Improve patient satisfaction
• Enhance availability of health information
• Enable electronic communication between
patient and care-team
• Increase Transplant Center efficiency
NLC 7 October 4-5, 2012 Transplant Track
Achieved through Patient Online
Services:
• Inbound messages received
– Kidney 2496
– Liver 608
– Heart & Lung 367
– BMT 240
• Strong patient and staff satisfaction
NLC 7 October 4-5, 2012 Transplant Track
One definition of change
management
“The process, tools and techniques used to
manage the ‘people side’ of change in order to
successfully achieve the required business
outcomes.”
Prosci 2011
NLC 7 October 4-5, 2012 Transplant Track
What do you
consider the
main obstacles
to successful
change?
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23
Approval
process
Changing
Budget Corporate
constraints Culture
Mindsets
and
Attitudes
Underestimating
Project
Complexity
Legal
barriers
3 most common obstacles to project success
(based on industry research)
NLC 7 October 4-5, 2012 Transplant Track
Change Comfort / Risk Model
1st communication or 1st rumor
Dept A
Dept C
Increasing
fear and
resistance
Comfort/security
Normal work environment
Productivity loss
Worry/uncertainty
Decreasing
productivity
Employee dissatisfaction
Passive resistance
Dept B
Flight/risk
Dept D
Time
NLC 7 October 4-5, 2012 Transplant Track
Turnover of valued
employees
Tangible customer impact
Active resistance
Top Five Contributors to
Successful Change
1. Active and visible executive sponsors
2. Structured change management approach and
plan
3. Engaged mid-level managers and supervisors
4. Involved front-line staff
5. Frequent and open communications
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26
ADKAR
Nature of the change
Drivers for change (internal-external)
Risks of not changing
What is changing
Impact of the change
the change
WIIFM (What’s in it for me)
Willingness to support change
Personal choice, influenced by nature of change
Personal situation
Intrinsic motivators
Knowledge about how to change
Ability to implement new skills
Training & Education of skills and expected behavior
Detail on how to use new processes, systems & tools
Understanding new roles & responsibilities
Awareness of the need to change
Desire to participate and support
and behaviors
Reinforcement to keep the
change in place
Putting knowledge into action
Individual or group demonstrates capability to
implement change at the required performance level
Sustains change, prevents relapses
Builds momentum
Creates a history (Absence of negative consequences
Recognition, Accountability)
27
NLC 7 October 4-5, 2012 Transplant Track
Without ADKAR
In absence of:
You will see:
Awareness
• More resistance from employees.
• Employees asking the same questions over and over.
• Lower productivity.
• Higher turnover.
• Hoarding of resources and information.
• Delays in implementation.
and
Desire
Knowledge
and
Ability
Reinforcement
• Lower utilization or incorrect usage of new processes, systems
and tools.
• Employees worry if they are prepared to be successful in future
state.
• Greater impact on customers and partners.
• Sustained reduction in productivity.
• Employees revert back to old ways of doing work.
• Ultimate utilization is less than anticipated.
• The organization creates a history of poorly managed change.
NLC 7 October 4-5, 2012 Transplant Track
ADKAR Profile
5
Barrier Point
4
3
2
1
0
A
D
K
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A
R
Patient Portal Implementation:
Awareness
•
•
•
•
Engaged physician champion
Formed cross-functional project team
Performed stakeholder analysis (ARCIVD)
Established weekly meetings for workflow
mapping, process integration, and
identification of concerns
• Engaged Patient and Family Advisory Council
NLC 7 October 4-5, 2012 Transplant Track
Patient Portal Implementation:
Desire
• Identified key messages linked to personal motivators
• What’s in it for patients?
–
–
–
–
Connect with their care-team
Communicate on their schedule
Reference previous messages to avoid misunderstanding instructions
Request appointments
• What’s in it for the Transplant team?
–
–
–
–
–
Connect with your patients
Stop playing phone tag
Manage tasks on your schedule
Automatic creation of a clinical note
Clear, concise, documented communication
NLC 7 October 4-5, 2012 Transplant Track
Patient Portal Implementation:
Knowledge
• Staff education developed to
– Activate patient portal accounts
– Triage messages
– Respond to messages
– Effectively educate patients
NLC 7 October 4-5, 2012 Transplant Track
Patient Portal Implementation:
Ability
• ABILITY to succeed was achieved through
preparation
• Onsite support during go-live
• Resources such as reference guides and FAQs
• Availability of subject matter experts for
support
NLC 7 October 4-5, 2012 Transplant Track
Patient Portal Implementation:
Reinforcement
• Recognition of “outbound messaging champions”
• Regular progress communications, sharing of
results
• Data monitoring to identify and assist specific
areas
• Celebrating success stories
NLC 7 October 4-5, 2012 Transplant Track
NLC 7 October 4-5, 2012 Transplant Track
Change Management Roles
Executives
&
senior
managers
Middle
managers
&
supervisors
Employees
impacted
by change
Project
resources
/ team
Change
management
team
Adopted
from
Prosci
2011
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Change Management Process for
Leaders
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37
Resistance is the norm, not the
exception
Establishing guidelines for
managing resistance
BEFORE resistance is
encountered …
…increases the likelihood
of a successful transition
from current to future
states.
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What does resistance look like?
•
•
•
•
•
Lack of participation
Openly expressing negativity
Lack of attendance and absenteeism
Reverting to old ways
A decrease in productivity and missed
deadlines
• Persistent challenging of specific components
of change
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Communicate directly
• Why are we changing?
• What will happen if we don’t
CEO/President
change?
•Executive
How does
this fit our
manager
• vision/strategic plan?
Senior manager
Department head
The employee's supervisor
Translates change
for employees:
• How will the change impact
me and the way I do my work?
• What support are you providing
to me to make the change?
Project team member
Project team leader
Executive
Sponsor/Owner
CM team member
Personal messages
CM team leader
Business messages
Other
0%
10%
20%
30%
40%
50%
60% Manager/
Percent of respondents
Supervisor
Prosci’s 2011 Best Practices in Change Management benchmarking study
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Communication Checklist
Message
and when shared
Key messages
Group messages when possible, use multiple channels
Recommended
deliverer of the
message
About the Business
shared during earliest
stages of the change
Current situation & rationale for change
Business issues or drivers
Financial issues or trends
The risk of not making the change
Vision of the organization after the change
Primary
Primary
Primary
Primary
Primary
About the change
shared after
employees
understand the
business situation
About how change
impacts employees
shared concurrently
with above
sponsor
sponsor
sponsor
sponsor
sponsor
Scope of the change (incl process, org, technology)
Primary sponsor
Alignment of the change with business strategy
Primary sponsor
How big of a change is needed (how big is the gap between current & future state) Primary sponsor
The basics of what is changing, how, when and what will not change
Front-line supervisor
Expectation that change will happen and is not a choice
Primary sponsor
Implications on job security
Primary sponsor
Impact of the change on day-to-day activities
Employee What's In It For Me (WIIFM)
Procedures for getting help during the change
Ways to provide feedback
Specific behaviors and activities expected from employees
Front-line supervisor
Front-line supervisor
Front-line supervisor
Front-line supervisor
Both
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Assessing your current state
A
D
A
W
A
R
E
N
E
S
S
List the reasons you believe this change is necessary.
D
E
S
I
R
E
List the factors or consequences (good and bad) for this
group that create a desire to change.
1.
Review these reasons and ask yourself the degree
to which staff are aware of these reasons. Rank on
a 1 to 5 scale.
1 Not
aware
of the
reasons
2.
3.
4.
5 Fully
aware
of the
reasons
5.
Consider these motivating factors. Assess the
desire of the staff to change. Rank on a 1 to 5
scale.
1.
2.
3.
4.
5.
1 Little
desire
to
change
NLC 7 October 4-5, 2012 Transplant Track
5 Strong
desire
to
change
42
What Now?
Barrier point (1st area
scoring 3 or below)
Potential response(s) / Action items
Awareness
Communicate the reasons the change is necessary.
Emphasize patient value. Consider Sender/Receiver concept.
Think 5-7 times … multiple channels …
Desire
Address their inherent desire to change. Desire may come
from negative or positive consequences.
Knowledge
Provide the needed education including day-to-day work
changes and new performance measures.
Ability
Time is required to develop new abilities.
Provide visible ongoing coaching and support.
Reinforcement
What is preventing staff from reverting back to old behaviors.
Address the incentives or consequences for not adopting the
change.
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Not everyone changes at the same pace
Person A
A
D
A
Person B
Person C
K
A
A
D
K
D
A
A
D
K
A
A
D
Person H
A D
K
Person I
44
R
A
D
K
A
Person F
Person G
A
K
Person D
Person E
R
A
A
R
R
D
K
R
K
A
A
R
R
R
A
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D
K
A
R
Points to Remember
• Successful aggregate change requires
individual change
• A structured approach to managing change
will significantly increase our success
• Successful change begins with each of us
• Achieving patient & family centered care
depends on us all doing this well!
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References
Books
Best Practices in Change Management, Prosci Benchmarking Report
Change Management: The People Side of Change.
ADKAR: A Model for Change in Business, Government and Our Community. (also
available in Mayo library)
Kotter, John. Leading Change. 1995. Harvard Business School Press
Articles
Kotter, John. Leading Change: Why Transformation Efforts Fail.
March – April, 1995. Harvard Business Review
Web sites
Prosci http://www.change-management.com/
Quality Academy http://mayoweb.mayo.edu/quality-learning/qa-templates.html
EPMO http://mayoweb.mayo.edu/planning/epmochangemanagement.html
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Katie McKee
mckee.katherine@mayo.edu
507-266-8090
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Integrating
A Partnership In Healthcare
to Optimize Patient & Family
Centered Care
Patricia Geerdes, RN, MSN
Manager – Quality & Informatics
National Learning Congress
October 5, 2012 9:30 a.m.
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Mayo Clinic Rochester
Mission & Vision
Mission: Provide the best care to
Every patient every day through
Integrated clinical practice,
Education and Research.
NLC 7 October 4-5, 2012 Transplant Track
Vision: The NEEDS of the patient come first.
Patient Centered Care
• IOM Health Care Recommendation
• Payer Initiatives
• Future of Health Care: D. Berwick
– Secret to health care reform is to focus on the fami
as partners in their care.
– Build facilities and processes around the people wh
get the care rather than those who give the care.
– Allow patients to be the drivers of their healthcare,
passengers
– “Not from the bedside, but rather from the bed”
J. Conway
NLC 7 October 4-5, 2012 Transplant Track
Goal: Improve Overall Patient
Satisfaction
NLC 7 October 4-5, 2012 Transplant Track
Concept Background
• A venue to focus on the voice of the patient,
family members and caregivers
• Increase patient satisfaction with the
transplant experience
• Patient Family Advisory Councils are
established multiple areas:
–
–
–
–
Cardiovascular Diseases
Gastroenterology and Hepatology
ENT
Mayo Health System
NLC 7 October 4-5, 2012 Transplant Track
Drinking from the Fire hose…
NLC 7 October 4-5, 2012 Transplant Track
Transplant Patient and Family
Advisory Council (PFAC)
• Charge:
– Patient and family advisory council (PFAC) is dedicated to
building on Mayo’s tradition that “the needs of the patient
come first.” Patients, family, caregivers and Mayo
employees work as a team to develop changes through
improved processes and outcomes in the Transplant
Center
NLC 7 October 4-5, 2012 Transplant Track
Transplant Patient and Family
Advisory Council (PFAC)
• Goals:
– Collaboration between patients & families with Mayo employees of
the Transplant Center to improve the quality of service provided
– Assisting in the identification of opportunities that will improve
patient and family satisfaction
– Offering input to leadership in the planning and evaluation of
services
– Serving as a vital link between the Transplant Center and the
community
NLC 7 October 4-5, 2012 Transplant Track
Transplant Patient and Family
Advisory Council (PFAC)
• Council Composition
– Approximately 30 members (2/3 membership
patient/family)
– All programs represented
• BMT (Blood and Marrow Transplant), Heart, Lung, Liver,
Kidney, and Pancreas
• Live Donor
NLC 7 October 4-5, 2012 Transplant Track
Council Ideas
–
Wellness coaching (create energies, – Patient education (medically
decrease fear, increase support)
–
–
–
Mentoring, peer
– Compassion in healthcare
networking with people in
and among family
a similar situation (BMT
members
InfoNet, peers have credibility, validity)
– Spirituality, human touch
Importance of Support
and defining moments
groups
– Finance implications of
Caregiver component of
transplantation (pay for meds,
transplant (support and potential
counseling)
manual)
–
oriented, family education)
Mental health support (pretransplant, transplant, post-transplant,
PTSD implications analogy
– Gift of Life Transplant
House (value of experience, local
patients miss out )
NLC 7 October 4-5, 2012 Transplant Track
Evolution from Concept to
Expectation
Theory of Change
– Set the Stage
• Communication plan
– Decide What to Do
• Determine goals
– Make it Happen
• Identify barriers
• Evaluate effectiveness
– Make it Stick
• Review lessons learned
• Celebrate successes
NLC 7 October 4-5, 2012 Transplant Track
Outcomes: Improve Patient
Satisfaction
NLC 7 October 4-5, 2012 Transplant Track
Goal: Improved Efficiency
NLC 7 October 4-5, 2012 Transplant Track
Next Steps
• Quality initiative in updating educational materials
across the transplant continuum
• Patient focus in the transition from inpatient to
outpatient activity
• Assist with the development of health literacy initiatives
• Empower the collaboration of patient’s in their health
care
• Mentorship program
NLC 7 October 4-5, 2012 Transplant Track
Showcasing the
Patient Family Advisory Council
Patient and family centered care is an approach to health
care that shapes policies, programs, facility design and
staff day-to-day interactions. It leads to better health
outcomes and wiser allocations of resources, and greater
patient and family satisfaction.
NLC 7 October 4-5, 2012 Transplant Track
Mayo Clinic Rochester
Transplant Center
THANK YOU
For Further Information Contact:
Patty Geerdes, RN, MSN
geerdes.patricia@mayo.edu
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NLC 7 Transplant Track
Discussion
NLC 7 October 4-5, 2012 Transplant Track
Increasing Organ Acceptance
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Speakers
Kidney Turndown Review- Linda Munro
Increasing Kidney Transplants By Reducing
Cold Ischemic Time- Kathy Hogan
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Kidney Turndown Review
Linda Munro, RN, MSN
Transplant Institute
Henry Ford Hospital
October 5th, 2012, 10:30 am
NLC 7 October 4-5, 2012 Transplant Track
Outline
• Our Experience with Kidney Offer Reviews
• Tools/Resources
• Improvements
• Challenges
NLC 7 October 4-5, 2012 Transplant Track
History of Organ Offer Reviews
HRSA (2007) Key Change Concept 3.1
“Create high threshold for rejecting organ offers
and potential recipients”
Action Items
• Take steps to push the envelope on organ acceptance
criteria, including ECD and DCD organs
• Use data on whether organs that were rejected by
the center were accepted for transplant elsewhere
NLC 7 October 4-5, 2012 Transplant Track
Henry Ford Hospital (HFH)
Detroit, MI
NLC 7 October 4-5, 2012 Transplant Track
HFH Experience
• June 2009 started monthly meetings
• Review previous month’s offers:
Discuss organ offers where organs were accepted
after we turned down
Decide whether to track for 1 year graft function
Discuss revising clinical practices or deceased donor
criteria
NLC 7 October 4-5, 2012 Transplant Track
HFH Experience
Tools
• Organ Offer Report in DonorNet® shows all
electronic offers for a given month
• HFH Organ Offer Sheets completed by coordinator
• HFH Spreadsheet with pertinent donor/recipient data
• Review of Organs Offered and Transplanted (ROOT)
Report on Secure Enterprise Homepage under
‘Data Reports’ (tracking 1 year graft survival)
NLC 7 October 4-5, 2012 Transplant Track
Offers Excluded from
ROOT Report
• Organs recovered but not transplanted
• Candidates with the refusal codes below
(not inclusive):
802- multi-organ transplant
810- positive crossmatch
812- no sera
851- directed donation
NLC 7 October 4-5, 2012 Transplant Track
HFH Experience
• Attendance
Transplant Surgeons and Nephrologists
Pre Transplant Coordinators
Quality and Regulatory Compliance Manager
OPO Representatives
• Quality Spreadsheet
NLC 7 October 4-5, 2012 Transplant Track
July, 2012
MI Offers
Regional Offers (OH,& IN; not MI)
Out of Region Offers
33
6
61
TOTAL Offers Made (calculated)
Total Not Used / Transplanted
Total Transplanted / Accepted (calculated)
Quality Measurements
100
64
36
Organs offered to HFH
Organs turned down by ALL centers
Organs offered to HFH which were transplanted (by HFH and other centers)
Usability Rate (total offers accepted / Total offers made) 36%
Percent of organs offered, which were used for transplant
Total Transplanted / Accepted (calculated)
Total HFH Transplanted
Total HFH Accepted
Total Turned Down
Not Available for Review
Total Turned Down to Review (calculated)
Quality Measurements
HFH Acceptance Rate (HFH accepted / Total
Organs offered to HFH which were transplanted (by HFH and other centers)
Transplanted)
36
7
14
15
0
15
58%
Organs transplanted by HFH
All organs accepted as a provisional yes / back up but did not become primary
Organs turned down by HFH, transplanted elsewhere
Codes 802, 810, 812, 850, 851, 852, 853, 860, 861, 862, 863, 880
MUST BE REVIEWED
Percent of usable organs offered to HFH, which were accepted by HFH
HFH Improvements
• Transparency & Accountability
• Collaboration between Transplant Center & OPO
• Expanded donor acceptance criteria
Increased Cold Ischemic Time for ECD
Increased age for DCD donors
Increased maximum Creatinine
• Changed Clinical Practice
Nephrologist may be called to review offer
Turndowns are reviewed by second surgeon
NLC 7 October 4-5, 2012 Transplant Track
Challenges
• At times conflicting or missing information
• ROOT Report- unavoidable time lag in
reporting initial graft status (2 months)
• Depend on other transplant centers to
report graft status in a timely manner
NLC 7 October 4-5, 2012 Transplant Track
Looking to the Future
• Proposal to Update Data Release Policies would
expand information on ROOT Report
• In the process of reviewing our ECD graft
survival by Cold Ischemic Times
• We continue to review donor selection criteria
• We continue to expand our donor acceptance
criteria and protocols
NLC 7 October 4-5, 2012 Transplant Track
Thank You!
Contact Information
Linda Munro RN MSN
Quality and Regulatory Compliance Manger
Transplant Institute Henry Ford Hospital
313-916-2271
lmunro1@hfhs.org
NLC 7 October 4-5, 2012 Transplant Track
Increasing Kidney Transplants By
Reducing Cold Ischemic Time
Kathy Hogan, RN, BSN, CCTC
Nurse Manager
Transplant Institute, Henry Ford Hospital
NLC 7 October 4-5, 2012 Transplant Track
Objectives
Discuss the ability to adapt concepts of a
No Prospective Cross Match List as a
means to reduce cold ischemic time and
thereby increasing the number of decease
donor organs in the donor pool
NLC 7 October 4-5, 2012 Transplant Track
Criteria
•
•
•
•
•
•
First transplant
Male
Listed for kidney transplant only
No HLA Antibodies for past 6 months
Commit to supplying monthly sera
Compliant with all medical treatment
while awaiting transplantation
NLC 7 October 4-5, 2012 Transplant Track
The Team
•Surgical Program Director
•Medical Program Director
•Director of Transplant Immunology
Lab
•Supervisor of Transplant Immunology
Lab
•Quality and Regulatory Compliance
Manager
•Medical Assistant
NLC 7 October 4-5, 2012 Transplant Track
Quarterly Meetings
• Review each patient for:
–No development of HLA
Antibodys
–No sensitizing events
–No change in health status
–Compliance with all health care
requests
NLC 7 October 4-5, 2012 Transplant Track
Retrospective Review
2010-2011
• Cadaveric Donors (N – 116)
• Ischemic time 1030.97 minutes (17.18 hrs)
• Non-Prospective Crossmatch Donors (N – 16)
• Ischemic time 1022.6 minutes (17.04 hrs)
NLC 7 October 4-5, 2012 Transplant Track
Non-prospective
Crossmatch Donors
• 18 donors
• UNOS wait time – 2.2 years
• Ischemic time 1030.97 minutes (17.18 hrs)
– 10 SCD –Ischemic time 925 min (15 hrs)
– 4 DCD – Ischemic time 1025 min (17.1
hrs)
– 4 ECD – Ischemic times 1035 (17.2 hrs)
• 8/10 arrived on pump
NLC 7 October 4-5, 2012 Transplant Track
Non-prospective
Crossmatch Donors
• 9 patients had immediate graft function
• 9 patients required @ least 1 dialysis
treatment
• Average creatinine today = 2.35
• 2 patients are re-listed
– 1 primary non-function
– 1 renal vein thrombosis
NLC 7 October 4-5, 2012 Transplant Track
Summary
• 16 patients received kidneys that
would have previously turned down
for prolonged ischemic time if we had
to wait for prospective crossmatch
• Even though it appears ischemic times
are the same, technically they are not
• Greatly reduced UNOS wait list time
• No difference in graft function
between kidneys arriving on a pump
and those that did not
NLC 7 October 4-5, 2012 Transplant Track
Discussion
NLC 7 October 4-5, 2012 Transplant Track