1. Transplant Center Staffing: Stabilizing the Team Kandis Schwartz, BSN, MBA Director Transplant Services Intermountain Transplant Svcs

2. Intermountain Transplant Center
First kidney transplant performed 1983
Pancreas, Heart, Liver, Living Kidney and Liver
Medium sized program
100 kidneys, 5 pancreas, 15 hearts, 45 livers
50 living kidney donors, 1 living liver donors
History

3. Allocation Policy KAS Share 35 Increased waiting time
Pre-emptive transplant to ESRD time
Increased morbidity
Marginal kidneys
Long-term follow up
Co-management to dedicated management
Share 35
Import livers
High MELD at transplant
HCV is CURED
Allocation Policy
Life Happens

4. Snapshot of Impact The Big Ask 2014 2015 2016 Annualized 2017
2014
2015
2016
Annualized 2017 Δ
Referrals
362
366
347
376 4%
Evaluations
293
230
330
216
-26%
Re-evaluations
502
551
716
434
-14%
Post-transplant
407
444
885
1226
201%
Transplants
103 65 89 80
-22%
Living Donor Evals 66 78 92
40%
The Big Ask

5. Stabilizing the Team Kidney/Pancreas Program STAFFING FTE
Transplant Assistants – Pre 4
Transplant Coordinators – Pre 6
Living Donor Assistants 2
Living Donor Coordinator 1
Advanced Practice Clinicians (New) 3
Transplant Assistants – Post
Transplant Coordinator – Post
Quality Manager
0.5
Financial Coordinators
Data Coordinators
Kidney/Pancreas Program

6. Stabilizing the Team Liver Program STAFFING FTE
Transplant Assistants – Pre
1.5
Transplant Coordinators – Pre 3
Advanced Practice Clinicians 6
Transplant Assistants – Post 1
Transplant Coordinator – Post
Quality Manager
0.5
Financial Coordinators
Data Coordinators
Liver Program

7. Staffing Best Practice
Staffing Ratio?
Staffing Mix?
Roles and Responsibilities?
My Quest

8. 2018 Transplant Games
in Salt Lake City

9. Staff Ratios Stabilizing your Team
Jennifer M. Kerney, MSN, CRNP
Assistant Director, Transplant UCSF Medical Center
Carolyn V. Light, MPA
Director, Transplant Services UCSF Medical Center

10. Staff Ratios Stabilizing your Team
Increased:
referrals  need more staff
complexity  need more staff
post transplant volumes need more staff
regulatory compliance  need more staff

11. Staff Ratios Stabilizing your Team
Increased:
referrals  need more staff
complexity  need more staff
post transplant volumes need more staff
regulatory compliance  need more staff
Institutional budgetary concerns  manage labor costs!

12. LD application / eval per FTE post transplant visits per FTE
UCSF LIVER TRANSPLANT
ORGAN TYPE
LIVER
Referrals (per year)
561
Evaluations (per year)
318
Waitlist Size
750
Living Donor Applications (per year)
612
Living Donor Evaluations (per year)
115
Transplants (per year)
192
Post Visits (per year)
3484
Total Recipients Followed
2400
STAFFING
FTE
x/FTE x 
Intake AA
1.5
212
referrals per FTE
Intake RN
0.5
636
Waitlist AA 2
375
pts on waitlist per FTE
Waitlist RN
4.4
170
Living Donor AA 1
LD application / eval per FTE
Living Donor RN
Inpatient AA
384
transplants per FTE
Inpatient RN
Inpatient AHP 96
Post Transplant AA 3
800
post transplant visits per FTE
Post Transplant RN
Post Transplant AHP
5.5
436
Financial Counselors 5
342
109
Data Coordinators

13. LD application / eval per FTE post transplant visits per FTE
UCSF KIDNEY & KIDNEY/PANC
ORGAN TYPE
KIDNEY
PANC/K.P.
Referrals (per year)
2095 41
Evaluations (per year)
1211 35
Waitlist Size
4984 98
Living Donor Applications (per year)
1778
n/a
Living Donor Evaluations (per year)
294
Transplants (per year)
353 (101) 16
Post Visits (per year)
5212
Total Recipients Followed
7000
465
STAFFING
FTE
x/FTE
Intake AA
5.5
381
referrals per FTE
Intake RN 5
419
Waitlist AA 4
1246
pts on waitlist per FTE
Waitlist RN 6
831
Living Donor AA 3
LD application / eval per FTE
Living Donor RN
5.6
52.5
Inpatient AA
0.5
706
transplants per FTE
Inpatient RN
Inpatient AHP
88.25
Post Transplant AA
2.6
2692
post transplant visits per FTE
Post Transplant RN 2
3500
Post Transplant AHP
1400
Financial Counselors
342
109
Data Coordinators

14. LD application / eval per FTE post transplant visits per FTE
UCSF HEART TRANSPLANT
ORGAN TYPE
HEART
Referrals (per year)
150
Evaluations (per year)
151
Waitlist Size 24
Living Donor Applications (per year)
n/a
Living Donor Evaluations (per year)
Transplants (per year) 20
Post Visits (per year)
485
Total Recipients Followed
196
STAFFING
FTE
x/FTE
Intake AA 1
referrals per FTE
Intake RN
Waitlist AA 25
pts on waitlist per FTE
Waitlist RN
Living Donor AA
LD application / eval per FTE
Living Donor RN
Inpatient AA
transplants per FTE
Inpatient RN
Inpatient AHP
Post Transplant AA
post transplant visits per FTE
Post Transplant RN
Post Transplant AHP
Financial Counselors 2
 10
Data Coordinators

15. LD application / eval per FTE post transplant visits per FTE
UCSF LUNG TRANSPLANT
ORGAN TYPE
LUNG
Referrals (per year)
311
Evaluations (per year)
199
Waitlist Size 24
Living Donor Applications (per year)
n/a
Living Donor Evaluations (per year)
Transplants (per year) 49
Post Visits (per year)
1435
Total Recipients Followed
378
STAFFING
FTE
x/FTE
Intake AA 1
referrals per FTE
Intake RN 2
155
Waitlist AA
pts on waitlist per FTE
Waitlist RN 12
Living Donor AA
LD application / eval per FTE
Living Donor RN
Inpatient AA
transplants per FTE
Inpatient RN
Inpatient AHP 4
Post Transplant AA
post transplant visits per FTE
Post Transplant RN
358
Post Transplant AHP
Financial Counselors  2
 25
Data Coordinators

16. Staff Ratios Stabilizing your Team UCSF Since 2014
Liver Transplant Adds:
2 Post Liver Transplant AHPs
Kidney Transplant Adds:
2 Post Kidney Transplant AHPs
2 Pre Transplant (1 eval, 1 waitlist) RN
1 Pre Transplant RN
1 SW

17. Staff Ratios Stabilizing your Team UCSF Since 2014
YEAR
LIVER TRANSPLANT ADDS
Leverage Data
UCSF
Centers >150 Txs
2014
Post Transplant AHP Staffing
Number of AHPs
 2.5
 4.8
Transplants per FTE
 27.6
 17.5
KIDNEY TRANSPLANT ADDS
2015
124 40
Waitlist RN
Patients on waitlist per FTE
151.7
55.6
2017
Social Worker
2006.8
700.2
Evaluation RN -
Referrals per FTE
500.3
259.8
1064.7
836.1

18. Staff Ratios Stabilizing your Team UCSF Since 2014
YEAR
LIVER TRANSPLANT ADDS
Results
UCSF
Centers >150 Txs
2014
Post Transplant AHP Staffing
2 additional AHPs APPROVED
 2.5
 4.8
KIDNEY TRANSPLANT ADDS
2015
124 40
Pre Transplant AA
2 additional Aas APPROVED
151.7
55.6
2017
Social Worker
1 additional SW APPROVED
2006.8
700.2
Evaluation RN -
1 additional RN APPROVED
500.3
259.8
Waitlist RN
1064.7
836.1

19. Staff Ratios Stabilizing your Team UCSF Since 2014
YEAR
LIVER TRANSPLANT ADDS
Leverage Data
UCSF w/adds
Centers >150 Txs
2014
Post Transplant AHP Staffing
post tx visits per FTE
 27.6  19.7
 17.5
KIDNEY TRANSPLANT ADDS
2015
Transplants per FTE
124  74 40
Pre Transplant AA
Patients on waitlist per FTE
151.7  143.4
55.6
2017
Social Worker
1449
700.2
Evaluation RN -
Referrals per FTE
500.3  398
259.8
Waitlist RN
 884
836.1

20. Staff Ratios Stabilizing your Team UCSF Since 2014
UCSF LUNG TRANSPLANT
Staff Ratios Stabilizing your Team UCSF Since 2014
Lung Transplant Adds:
2 Post Lung Transplant AHPs
1 Medical Assistant
LUNG TRANSPLANT ADDS
Leverage Data
UCSF
Centers >150 Txs
Post Transplant AHP Staffing
Number of FTEs
2.5
4.8
Transplant MA
Transplants per FTE
27.6
17.5

21. Staff Ratios Stabilizing your Team UCSF Since 2014
UCSF LUNG TRANSPLANT
Staff Ratios Stabilizing your Team UCSF Since 2014
Lung Transplant Adds:
2 Post Lung Transplant AHPs
1 Medical Assistant
LUNG TRANSPLANT ADDS
UCSF
Centers >150 Txs
Post Transplant AHP Staffing
2 Additional AHPs APPROVED
2.5
4.8
Transplant MA
1 additional MA APPROVED
27.6
17.5

22. Staff Ratios Stabilizing your Team UCSF Since 2014
UCSF LUNG TRANSPLANT
Staff Ratios Stabilizing your Team UCSF Since 2014
Lung Transplant Adds:
2 Post Lung Transplant AHPs
1 Medical Assistant
LUNG TRANSPLANT ADDS
Leverage Data
UCSF w/adds
Centers >150 Txs
Post Transplant AHP Staffing
Number of FTEs
2.5  4.5
4.8
Transplant MA
Transplants per FTE
27.6  17.25
17.5

23. Staff Ratios Stabilizing your Team UCSF Since 2014

24. Future Considerations
How do we continue to ensure sufficient staffing to provide high quality care for our growing volume of increasingly complex patients?
Negotiate a rolling growth model with institutional commitment to expand –
for every XX transplants, increase by YY staff
Stable, long term post-transplants return to their hepatologist/GI/nephrologists for management of immunosuppression, etc.