1. Transplant Staffing Model at a Large Volume Lung Transplant Center
Kate Grief, RN, MSN, CCTC
Lung Transplant Program Manager
August 21, 2019

2. St. Joseph’s Hospital and Medical Center
Founded in 1895 by the Sisters of Mercy
600 beds
Level I Trauma Center
Not-for-profit
$188.7 million in community benefit during FY19
Partnership with Creighton University School of Medicine
Partnership with Phoenix Children’s Hospital
Neuro, Thoracic, Transplant, Living Donors, Mother & Baby, Congenital Heart, VAD
Norton Thoracic Institute

3. St. Joseph’s Hospital and Medical Center
Transplant Program
Volume Since Inception
Center of Excellence
CMS Approved Transplant Program
Lung*
788
Yes
Kidney 71
Liver 62
VAD 11
JCHAO
*Top 5 Nationally since 2016

4. Norton Thoracic Institute - Lung Transplant Program
738 patients total – as of April 4, 2019

5. Lung Transplant SRTR July 2019
Source: SRTR: Program Specific Report July 2019

6. Source: SRTR: Program Specific Report Jul 2019
Waiting Times
Source: SRTR: Program Specific Report Jul 2019

7. Performance Analysis - Transplants
*On track for 115+ transplants in 2019

8. Performance Analysis - Transplants

9. Dedicated Transplant Team
4 Financial Coordinators
7 Txp Surgeons
6 Txp Pulmonologists
10 RN Coordinators
Dedicated Pt care units
2 Social Workers
2 Pharmacists
1 Dietitian
1 Psychiatrist

10. Lung Transplant Program Protocols
Follow patients life long
Clinic visits 2 x per week for 2 weeks
Then 1x per week for 2 weeks
Then 1x every other week
Then monthly for the whole first year
Then every 3-6 months for lifetime
More frequent visits as clinical condition warrants
--5 year survival ~55%
--over 3000 clinic visits in last FY

11. Current Structure for Donor Offers/Transplant Events
Transplant Pulmonologist takes primary donor call
Second pulmonologist as “back up”
Fully evaluates every donor
Communicates with OPO
Determines provisional acceptance in collaboration with the transplant surgeon
Counsels patient if PHS Increased Risk
Participates in donor management
May be managing multiple donors
Hands off when we are primary or back up
-Rotated between the pulmonologists 1 week at a time
-Typically donor call while on service
--very rarely, RN may cover donor call
Not uncommon to be coordinating multiple transplants
Records is 3 in <24

12. Current Structure for Donor Offers/Transplant Events
Pulmonologist Hands off to On-call Transplant Coordinator
Communicates Donor ID/Match ID
RN takes over communication with OPO
Negotiates OR time
Coordinates transplant (procuring and implanting teams)
May be coordinating multiple offers/implants
Simultaneous and/or back to back transplants
DCD
OCS
ECMO
Other thoracic surgeon procuring
--Rotated between 10 transplant coordinators
--AOC on call at all times
--Algorithymic approach in place

13. Transplant Admission RN calls patient with organ offer
Makes NPO
Ensures ready for transplant
Notifies physician if any contraindications are identified
Requests bed
Negotiates time of admission
Physician/mid-level on call enters transplant orders
Takes phone calls re. recipient status while admitted

14. Transplant Event RN coordinates Procuring team Implanting team
Anesthesia
Perfusion
Coordinates timing for less than 6 hour ischemia time
Multiple algorithms
DCD
OCS
Retransplant
ECMO

15. Other Duties for RN on-call
Delisting following transplant
Notifying entire team transplant occurred
Triaging out-patient phone calls
May be assigned to clinic
First call for out patient critical lab values
Additional weekend duties
Follow up on pending test results
Bronchoscopy culture results
RN sign outs
Coordination of admission/discharges
---Goes through physician on call

16. Pro’s of Employed Team Additional opportunity to earn call-pay stipend
Institutionally less expensive than 3rd party service
Calling the patient for Transplant Event 
Problem solving/Critical thinking
Aware of institutional policies and protocols
Aware of surgeon preferences
Knowledgeable about recipients
--evaluated services, but will not use for thoracic at this time due to cost, ischemia time of t-organs and “well oiled machine”
--re-evaluating flat rate model for different call structures

17. Con’s of an Employed Team
Transplant can occur 24/7/365 (and they do!)
May not be able to relieve on call RN the next day
Coordinating multiple donor offers
Fatigue/Burnout/Turnover
--turnover with cost to institution

18. Thank you