Megan Bell, RN, BSN, CCTC & Courtney Lepis, RN, BSN

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

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

3. Transplant Volumes FY 2017-2019

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

5. Layers of Call Team/Call Team Structure RN-Transplant Coordinator Donor Allocation Specialist (DAS) Call Team Managers 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 Monthly Big Picture Day to Day 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 15-20 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

7. CALL TEAM RESPONSIBILITIES PATIENT MANAGEMENT OTHER PROJECTS OFFER 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

8. Offer Presentation

9. PATIENT CALLS/ TRANSFERS • Call team handles for all organs • Average of 10-12 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

10. Patient Communication

11. Communication with In-House Teams

12. Call Team Communication Report Call Team Meetings Charting 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

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 1 2018 • “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

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

15. Challenges Faced Clinical Emotional Logistical 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

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

17. Future of Call at Keck USC

18. Thank you!