1. Session #2: The Evolution of Donation Process and Planning Doug Miller 2013

2. 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.”

3. Today’s Discussion: Evolution 1.Planning for Donation 2.Donation in Process

4. 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

5. Yearly Organ Donation Assessment (YODA)

6. Hospital Development Plan

7. Switching Gears

8. 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

9. Overview of Key Steps 1. Supportive Family Care and Donor Management 2. Referral 3. Monitoring Patient Status 4. Medical Eligibility Determination 5. Obtain Consent 6. Initial Donor Data 7. Donor Organ Evaluation 8. Organ Placement 9. Resource Allocation for Organ Recovery 10. Organ Recovery 11. Post-Case Follow-up

10. 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

11. 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 triggers Calls Statline Provides information from chart Create 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

13. PDSA

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

15. What is a Potential Donor?

16. 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

18. Potential Donor Data for Next Hospital Cohort

19. DSA Metrics and Outcomes DSA Hospitals True Donor Potential True Conversion Rate (Goal=90%) Organs Transplanted Per Donor (Goal 3.45) Forward Focus Team Hospitals 33261%3.03 Hospital A2442%3.30 Hospital B1844%3.00 Hospital C1759%2.50 Hospital D1735%3.17 Hospital E1560%2.78 Hospital F1145%3.80 Hospital G743%3.00 Hospital H771%2.20 Hospital I633%2.50 Hospital J667%3.75 Other Hospitals2646%2.83 Entire DSA48657%3.01 Date Range: 01/01/2011-03/31/2013

20. How Do We Start?

21. 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

22. 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

23. 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?

24. Volunteer to Report out to Plenary?