Transplant Staffing Model at a Large Volume Lung Transplant Center

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 St. Joseph’s Hospital and Medical Center

3. St. Joseph’s Hospital and Medical Center *Top 5 Nationally since 2016

4. Norton Thoracic Institute - Lung Transplant Program

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

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

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

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

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

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

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

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

18. Thank you