Multi-Departmental Team: Aspirus Alliance Multi-Departmental Team: Dr. Kris Lahren: MD, Pulmonologist, Forward Focus Faculty Member Sandy McCrory: ICU RN, MSN, Donation Liaison, Forward Focus Co-Lead Barb Heilmann: ICU RN Pam Mootz: ER RN Susan Tobin: RN, BSN, NE-BC, Manager Surgical Services Denise Falkowski: OR RN Christine Sullivan: AIM, Chaplain

Starting the Expedition (The start of the journey) We joined the collaborative. We completed our first improvement project. Talking points for the first bullet point: Selected the Team Completed Pre-Work (Reviewed past data) Attended Learning Session 1 (learned about QI tools) Talking points for the second bullet point: Analyzed quantitative data and identified areas for improvement around huddles. Then there were no donor or potential donor cases for five months (mid-March to mid/late-August). So we did a mock scenario and learned the problem (huddles) wasn’t really the problem but the mock scenario highlighted that communication was an issue. But still no current donor or potential donor cases/data to work with. “Fishing” with no luck 2

Casting a Wider Net (Shifting our Focus) We attended Learning Session 2 and were introduced to a new tool to help guide teams on case review. We adapted the tool based on the data review. We added, deleted and modified the categories in the tool to better fit our historical data set and known trouble spots. Hand out blank tool to all attendees. Briefly explain the tool (it looks at each step of the donation process and then codes it red, yellow, or green based on how smoothly that piece of the process went) – this is the ADAPTED version that Aspirus uses Talking point for the first bullet point: We had a flurry of activity following the learning session but had no method to study this data. Used the tool we learned about in the learning session to review the recent data (at that point the data was historical). First potential donor was 20 August 2012 then two more potentials and a donor were reviewed. Used the tool for the first time 04 Dec 2012 for all four cases. Can mention that the tool is outlined on the poster as well and there are copies of the tool available near the poster. 3

Catch of the Day (Current State) Then we started using the tool promptly after every donor and potential donor case. Now we are using the tool to discuss and reflect on each donor and potential donor case as a standard part of our donation process. Talking points for grid visual: Collected a lot of data and here is what we did: Put the data in grid to identify trends. Started making small, immediate changes based on the data in the tools (order sets, real-time staff coaching/follow up, consent form issues, brain death guidelines) Using trend data to support a larger, improvement initiative (physician role, family support, consent). Directly after we started using the tool we had a streak of four donors in December 2012 and January 2013 and one potential in March 2013. 4

Trophies (Takeaways) Not every change has to be big. If something isn't working then try something else – it is not a failure to try multiple things until something works. Having a structured way to review donor and potential donor cases can help the team better identify areas of improvement. Study every potential and donor case for both what worked and didn’t work. Using consistent language with clear definitions for all was a takeaway from the mock case scenario