1. Megan Bell, RN, BSN, CCTC & Courtney Lepis, RN, BSN
Region 5 Collaborative
Transplant center offer management- Internal Call Team
August 21, 2019
megan

2. Keck USC Transplant Institute
Multi-organ transplant center
Heart, lung, liver, kidney, pancreas
COE for kidney transplant
Large living donor program for liver
155 transplant employees
megan

3. Transplant Volumes FY 2017-2019
megan

4. History of Handling Organ Offers at Keck USC
Traditional method
Office coordinators rotate call
Coordinators are in the office M-F
1 coordinator on for liver, 1 for kidney/panc, 1 for heart, 1 for lung
Backup call as needed
4 primary coordinators paid per day plus 1-2 backups a day
Call is a side task not a primary job
Done in office M-F 8-5
At home nights/weekends/holidays
May 2017
Transplant Coordinators had just become union positions
Call a hot issue
Idea of separating out call developed
Two organ allocation managers hired
Structure of call redefined
megan

5. Layers of Call Team/Call Team Structure
Call Team Managers
RN-Transplant Coordinator
Donor Allocation Specialist (DAS)
2 on call managers
1 on call at all times
Step in to help with issues
Middle man with physicians/surgeons/OPO
Implement processes/protocols
Scheduling, training, etc.
4 FTE
2 per-diem  hiring a 3rd
1 on at all times (12 hour shifts)
Cover call for all organs
Review of all cases, patient charts
Patient calls for all programs
Transfers, re-MELD’s, urgent listings, status updates
5 FTE
Non licensed
Hourly position
Assist the RN as directed
Review offers with physicians/surgeons
Write up offers
Case set-ups
Special projects as needed
All team members are home based

6. Management of Call Department
Day to Day
Monthly
Big Picture
On call as back up 24/7
Middle man for doctors/preferences
Ensure consistency
Quality control-QA charting, etc.
Manage work flow
Ensure safe staffing levels  determine when to call in extra staff and who to call in
Transportation guidelines
Avg Calls per Day
per day most days
As little as 10
100+ on busy days
Data Collection
Offer Decline Reports
Transplant Log
Dash Boards
Billing
Schedule
4 weeks
Vacation
Changes
Staff Management
Structure
How many special projects going at any given time
Protocols
Processes
Workflows
PI Projects
courtney

7. CALL TEAM RESPONSIBILITIES
OTHER PROJECTS
OFFER MANAGEMENT
PATIENT MANAGEMENT
Review/write up offer
Present offer to physician
Code appropriately in UNOS
Follow cases to see outcome
Communicate with OPO staff
Review chart for readiness
Call patient to let them know we have an organ  patient assessment in real time
Case setup/patient admission
Patient calls- Pre & Post
Lab reviews
Transfers
Re-melds, urgent listings, status updates
Partner with waitlist teams
TIEDI forms
Assist living donor team
Remove all living donor recipients from UNOS within 24 hours of transplant
Facilitate getting vessels from other transplant centers or OPO’s as needed
Eval Reviews
Calling patients after-hours as needed
courtney

8. Offer Presentation
Auto rule outs go to manager; be presented by RN or DAS; can be held overnight; RN reviews all offers; charted in real time- MEGAN

9. PATIENT CALLS/ TRANSFERS
Call team handles for all organs
Average of a day
Guidelines in place on what to call on and what to handle
All critical labs called
Med refills handled by nurse
Transfers
Facilitated by call team
Urgent listings
Call team manager directs
Ad hoc committee
Status updates
Re-MELD all in house patients
Heart status updates
megan

10. Patient Communication
Patient called for transplant by RN or DAS  evaluation of patient done
Issues escalated to in-house team/coordinator if needed
sent out to in-house team so they know patient is being admitted/ stand-by
Patient Communication
megan

11. Communication with In-House Teams
Daily report sent out to each organ program
Patient calls
Waitlist follow-ups
Case set-ups
Waitlist meetings
Share point to document needed follow-up s
Communication with In-House Teams
megan

12. Call Team Communication
Charting
Report
Call Team Meetings
Housed in SharePoint
Real time documentation of offers, patient calls, follow-up needed
Case set-up forms
Recipient forms
Call ”Bible”
Dedicated conference line that all incoming/outgoing and manager call in to twice a day
Weekly conference calls
Committees to encourage staff participation
Scheduling
Staff Development
Education
Technology
Special Projects
Special Trainings
megan

13. Call Team Implementation Timeline
Summer 2017
Union/HR negotiations for positions
Structure of team developed
Fall/Winter 2017
Positions posted
Interviews held
Jan/February 2018
5 RN and 5 DAS (donor allocation specialist) hired
Spring 2018
Training of call team
July
“Go live”: organ offers for liver & lung
Patient calls for liver, kidney & lung
September 2018
Organ offers for kidney/pancreas
Heart case set-ups
August 2019
Organ offers/patient calls for heart
courtney

14. Call Team Training 10 staff started and needed to be trained at once
Utilized NATCO online training
Filtered through all departments & clinics
Shadowed call with managers
Real time training to alter the process
courtney

15. Challenges Faced Logistical Clinical Emotional Union negotiation
Staffing needs/call team design
Budgeting constraints
Scheduling model-24 hour call vs 12 hour call
Training a brand new department
Not just “one” way to do call
Development of processes and protocols
Charting & documentation of call
Changing a culture  call team now off site/covered by a different group
Physician & staff buy-in
Ongoing & expected challenge
courtney

16. Benefits of an Internal Call Team
Own the process
Can shape/develop as your institute sees fit  what works for one center, may not work for another
Specialize to different departments
Change as programs change and grow
Not everything needs to be a formal process
24/7 coverage for after hour projects  feast or famine
Build relationships with OPO’s
Benefits of an Internal Call Team
megan

17. Future of Call at Keck USC
Continue to fine-tune the process
Written Processes
Consistency
MD Preferences
Department Partnership
Growth of each organ department  growth of call team
megan

18. Thank you!