Organ Procurement Organizations

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November 2006
Presenter Carla Talley Hentz, MSCollaborative
Specialist OneLegacy
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Spanning Southern California

• 7 counties
• 220 hospitals
• 14 transplant centers
• 18.3 million (population)

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Why Are We Here?

• To Bring Hope to
• Donor families in their darkest hour
• Patients awaiting a life saving or enhancing
  organ
• Nationally 92,357
• California 19,294
• LA Service Area 8,308
• Patients in need of tissue and eyes

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Liver Waitlist Transplant Activity
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Kidney Waitlist
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Graft Survival Rates
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Donor History
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Why The Increase?

• Organ Donation Breakthrough Collaborative
• AIM 75 Conversion Rates in the top 325
  hospitals
• Began September 2003
• Ended May 2005
• Achieved AIM in 184 hospitals
• LA DSA Achieved AIM in 8 of 58 top donor
  potential hospitals 2004
• LA DSA Achieved AIM in 23 of 58 top donor
  potential hospitals 2005

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What Is The Collaborative About?

• Applying the Model for Improvement to achieve the
  AIM of 75 Conversion Rate
• Based on
• Will to change
• Ideas that will lead to improvement
• Execution of the ideas to achieve the goal

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We Know What Works

• Players as self-directed teams
• Aim statement that can be tracked
• Evidence-based concepts to play with
• Implementation through rapid testable actions
  that generate learning and results

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We Know What Works

• Focused on Results
• Data Driven Decisions
• Test Ideas rather than creating the perfect from
  scratch
• Team Work in Action
• Creativity Unleashed and Welcomed
• Build on Existing Knowledge

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What Is Your Success Headline?

• By October 2006, our team will have fulfilled
  its dream! The new reality we created
  is___________________, which has enhanced the
  organ transplantation system by___________________
  .

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What Do We Measure?

• Referral Rate
• Timely Notification Rate
• Effective Request Rate
• Conversion Rate
• ME Denials
• DCD Rate

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How Will We Achieve?

• Emerging High Leverage Changes
• Advocate Organ Donation As the Mission
• Involve Senior Leadership to get Results
• Deploy a Self Organizing OPO/Hospital Team
• Practice Early Referral, Rapid Response
• Master Effective Requesting
• Implement Donation After Cardiac Death

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How Will We Achieve?

• First Things First
• Physician clinical champions are known
• Process in place for real time MRR
• OPO Presence (in-house coordinator)
• Clinical Triggers in use
• Effective Requesting in place, in action
• Team Huddles are the norm
• Focused change agenda based on analysis of
  current hospital data
• After Action Reviews are the norm

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Find A Promising Change Idea

• What is Your Idea for achieving the 75
  conversion rate AIM?
• Wouldnt it be nice if we could
  try_________________?

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PDSAs Are The Norm

• Plan This is what we want to do
• Do This is how we will do it and how we will
  measure it
• Study This is the result and what we learned
• Act This worked or it needs to be modified
  and tested again

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What Excites Us about PDSA?

• Simple Anyone can rapidly learn and apply
• Proactive Constantly generating effective
  solutions
• Speed Create system-level improvement at a
  rapid pace
• Confidence Changes made really do result in
  unprecedented levels of improvement

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What Has OneLegacy Done?

• Improved Rapid Response
• Increased Administrators on Call
• Increased Hospital Services Coordinators
• Introduced Family Care Coordinators
• Introduced Hospital Services Liaisons
• Introduced Coroner/ME Liaisons
• Introduced Collaborative Coordinator
• Increased Community Outreach
• Established OneLegacy as the only tissue recovery
  agency in DSA effective June 26, 2006

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What is OneLegacy Doing?

• We are testing new PDSAs
• After Action Review Process Improvement Tool
• Tissue After Action Review Process Improvement
  Tool
• New MRR Tool to capture DCD potential
• New DCD Evaluation Tool
• Morning Donor Referral Quality Reviews

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National Donor History
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One Legacy Donor History
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Spread Strategy

• Annual Awards Recognition Conference
• Celebrating Our Partners
• Annual Fall 4-City Tour Learning Sessions
• November 1, Glendale
• November 7, Bakersfield
• November 9, Orange County San Bernardino
• November 16, Santa Barbara
• January 6, Palm Springs

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Whats New?

• Organ Transplant Breakthrough Collaborative
• Began October 2005
• AIM Increase organs transplanted per donor
• SCD 4.3
• ECD 2.5
• DCD 2.75

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Change Package

• Intent Rule-in vs Rule-out Philosophy
• Relationships Improve transplant center
  relationships and communication
• Advance Practice Maximize organ quality
  every organ every donor every
  time
• Push Push information to maximize organ
  placement
• Pull Pull information to maximize organ
  placement resources

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Applied Methods for Increasing Organs Transplanted
Internal Directives

• 1. The Push-Pull PDSAs with Tangible Results
• Pediatric small bowel placement protocol
• Pancreas placement protocol
• 2. Improve Donor Management
• Standard guidelines for donor management
• Longer time on site donor management before
  testing
• (i.e. bronchs, echo's)
• Aggressive placement of organs
• 3. Rule in vs. Rule out philosophy
• Transplant center determines suitability
• Serology NAT testing

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Transplant Center OPO Relationships

• 1. OPO/Transplant Center Liaisons
• OPO liaison partnered with each transplant center
  
• Routine rounds post-transplant debrief
• Immediate QA of donor/transplant issues
• Continue building and nurturing effective
  relationships
• In-House Transplant Center Liaison ( Pilot)
• Reviews organ dispositions for acceptance/declines
  organs exported
• Quarterly Organ Specific Transplant Center Sub
  Committee/OPO Conference Calls
• Discuss issues-policy changes-monthly/yearly
  organs transplanted
• Chair of sub committee to give OPO advisory board
  report
• Medical Advisory Board
• Representation of every transplant center/organ
  specific department
• Develop inter-center relations
• Policy Decisions
• DCD Organs Accepted

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OneLegacy Performance 2004 - 2006 (projected)
Organs Transplanted
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OneLegacy Performance2004 2006 (projected)
Organs Transplanted
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Whats Next ?

• Local Spread ODBC
• Local Hospitals
• Local Spread OTBC
• Local Transplant Centers
• Medical Examiners/Coroners
• Engaged in ODTBC (October 2006)
• Push-Pull with Transplant Centers/OPO
• PDSAs
• Increase DCD organs transplanted
• Meet projected number organs transplanted