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High Quality Renal Transplantation: Efficiency Counts

High Quality Renal Transplantation: Efficiency Counts. David R. Holt, M.D., F.A.C.S. Susan Hou, M.D. David Hatch, M.D. Claudia Peano, M.D. Dadi Ding, R.N. Billie Kostro, R.N. Mary Kay Larson, R.N. Anita Pakrasi, R.N. Laura Michalski, Pharm. D. Opportunity Statement.

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High Quality Renal Transplantation: Efficiency Counts

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  1. High Quality Renal Transplantation: Efficiency Counts David R. Holt, M.D., F.A.C.S. Susan Hou, M.D. David Hatch, M.D. Claudia Peano, M.D. Dadi Ding, R.N. Billie Kostro, R.N. Mary Kay Larson, R.N. Anita Pakrasi, R.N. Laura Michalski, Pharm. D.

  2. Opportunity Statement Although the renal transplant program enjoyed good results with regard to rejection and survival rates, it was felt the quality of the program could be maintained while shortening the initial hospital stay and decreasing costs. Goal: To establish a protocol for postoperative care and immunosuppression which would decrease the initial length of stay and costs for transplantation

  3. Most Likely Causes • Previous protocol for induction immunosuppression required hospitalization for infusion • Special laboratory tests were necessary for monitoring induction immunosuppression adding costs • Initial kidney function monitoring and patient follow up were performed on an inpatient basis

  4. Implementation • New induction immunosuppression protocol was devised making use of alternative immunosuppressive medications • Postoperative protocol modified to make more use of homecare nursing • Clinical follow up of patient • Laboratory blood draws

  5. Results-Length of Stay

  6. Results-Cost Average Quarterly Direct Cost for DRG 302: Kidney Transplant Pre_Implementation Implementation 55,000 Mean = $42,776 50,000 45,000 40,000 Mean = $35,236 Average Direct Cost 35,000 30,000 25,000 20,000 CY00-Qtr 1 CY00-Qtr 2 CY00-Qtr 3 CY00-Qtr 4 CY01-Qtr 1 CY01-Qtr 2 CY01-Qtr 3 CY01-Qtr 4 CY02-Qtr 1 CY02-Qtr 2 CY02-Qtr 3 CY02-Qtr 4 CY03-Qtr 1 Quarter

  7. Results-Acute Rejection Rate • Rejection rate within 1 year of transplant • 7.9% • All patients successfully treated and have functioning graft

  8. Results-1 Year Survival

  9. Conclusions and Next Steps • By revising the renal transplant induction immunosuppression protocol and making better use of homecare nursing we have reduced both length of stay and costs for renal transplantation while maintaining excellent patient outcomes.

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