One Day Evaluation

1. One Day Evaluation July 22, 2014 | 3:00pm – 4:00pm ET

2. Save the Date! Please Register at: www.organdonationalliance.org

3. Transplant Quality Resource Guide and Tools (TQRGT) The TQRGT is a road map incorporating best practices for developing and sustaining high quality, patient-centered excellence in donation and transplantation. Included are strategies, change concepts, actions, robust resources, templates, and worksheets intended to enhance the infrastructure and operations of all transplant programs. To view the TQRGT, please visit: www.organdonationalliance.org/educational-resources/transplant-toolbox/ Or go to www.organdonationalliance.org and click on the resource tab

4. Upcoming Webinar August 26, 2014 - 3:00pm ET Donor/Recipient Communication and Confidentiality The full 2014 Calendar of Webinars is available at www.organdonationalliance.org, Meetings & Webinars

5. Speaker MichalynPelphrey, RN, MSN, ACNP, CCTC Liver Transplant Coordinator Comprehensive Transplant Center Cedar-Sinai Medical Center Los Angeles, CA

6. One Day Transplant EvaluationMichalyn Pelphrey, RN, MSN, ACNP-BC, CCTCLiver Transplant

7. Background Process Improvement Group Formed in 2006 • Surgical Director • Coordinators • Social Worker • Financial Coordinators • Management Assistants • Met Weekly for 2 hours for 4 months • Goal- Identify areas of inefficiencies in our transplant process • First identified area- Evaluation Process

8. Evaluation Process Old System • Referral • Sent to Pre Transplant Management Assistant • Record Review • Pre Transplant Coordinator • Financial Clearance • Dedicated Financial Coordinators • Evaluation Scheduling • Completed by Pre Transplant Management Assistant • Multiple different days to complete all appointments

9. Problems Identified • Each individual consultant and department for testing called to arrange a schedule for each patient • Even with best efforts, evaluation would be spread over several days/weeks • Areas of hold up for listing: • PPD testing and readings (placement and reading) • Dental Clearance • Patients missing appointments due to multiple days of scheduling • Enormous amounts of time trying to arrange schedules • Multiple departments • Multiple consultants

10. Problems Identified Difficulty for patients to travel the Los Angeles area multiple days. • Most patients come from a distance, requiring long hours on the road for the commute back and forth. • Los Angeles County is over 4000 square miles with a population of over 10 million people. Evaluations were prolonged due to all of these logistical issues. Delay in listing patients.

11. Ideas for Solutions Would it be possible to do the entire evaluation in one day? What would it require to make this happen? How would we get patients to and from each department in a timely fashion? How can we resolve other factors causing delay in listing • Dental clearance • PPD testing

12. Why One Day? All patients have a life threatening disease! Cancer exception points • Clock is ticking Patient Satisfaction • Time off of work • Financial hardship • NPO multiple days • Transportation • Compliance

13. Next Steps Meetings with Departments to request weekly reserved time on one day of the week • Imaging Department • CXR • MRI of abdomen (5 time slots) • Pulmonary Lab • PFT’s with ABG (5 time slots) • Cardiac Department • EKG • Stress Echocardiograms (5 time slots)

14. Next Steps Meetings with each Consultant requesting availability for set weekly time period availability • Cardiology • Nutrition • Psychiatry • Social Work Meeting with Dental Clinic • Could Dental residents see patients for dental clearance during clinic with other consultants

15. Tracks Developed • Made 5 Tracks of schedules • Each patient assigned to a Track

16. New System Referral • Intake by Pre Transplant Management Assistant Review of Records • Performed by Pre Transplant Coordinator Financial clearance for initial appointment • Clearance for initial Hepatology consult Patients sent to local lab to complete evaluation lab testing • Serologies, tumor markers etc. Hepatology appointment- • Determine suitability for full evaluation • Scheduled by Pre Transplant Management Assistant

17. New System Cont. Financial Clearance for Evaluation Day • Financial coordinators request authorization • Evaluation consults • Evaluation testing • Stress echo • PFT’s • CXR • EKG • MRI of abdomen • Labs

18. New System Cont. Evaluation Day Scheduled • Held on Wednesdays • Scheduled with the patient and caregiver by the Pre- Transplant management assistant • Each patient assigned to a track • Track schedule emailed to each department on the Friday prior to the next Wednesday with patient name, MRN, DOB etc for each track. • Departments may release reserved slots at that time if all of the reserved slots are not being used for that week

19. Evaluation Day Patients arrive at 6:15 am for registration Met by Pre-Transplant Management Assistant and Volunteer Ambassadors to assist with registration and navigate hospital Morning 7:00am-11:45am • Lab • PFT’s • EKG • Stress Echo Lunch – 12:00pm-1:00pm • Pre transplant teaching by Coordinator • Box lunch for patients and caregivers

20. Evaluation Day Afternoon 1:00pm-4:30pm) • Clinic (Consults) • Surgery • Cardiology • Nutrition • Dental • Finance • Psychiatry • Social Work • Anesthesia

21. Evaluation Day Late afternoon (4:30pm-6:30pm) • Imaging • MRI abdomen • CXR Long day • Approximately 12 hours

22. Transplant Ambassadors Post Liver Transplant Volunteers Vital to completing evaluation testing Navigate the hospital Share experience Benefits everyone!

23. Patient Evaluation Schedule

24. Abstract Aim to assess efficiency of the one day evaluation • Written by Kristine Acorda, NP, Shi-Hui Pan, Pharm D and Steven Colquhoun, MD • Presented at NATCO meeting • Studied • Referral to evaluation time • Evaluation to patient selection committee time • Patient selection to UNOS listing time

25. Methods for Abstract Implemented on February 14, 2007 Study Period • Traditional evaluation -February 1, 2006 to January 31, 2007 • One day evaluation- June 1, 2007 to May 31-2008 • Learning period –February 14, 2017 to May 31, 2007

26. Methods for Abstract Study patients • Traditional eval N=162 • One day eval N= 153 • Retrospective comparison • Referral to eval • Eval to patient selection • Patient selection to UNOS listing or denial Statistic analysis: 2-tailed T test

27. Results

28. Conclusions Significantly reduced time • Eval to Patient Selection • Patient Selection to UNOS listing • Referral to eval remained the same Efficient Transplant Evaluation

29. Questions You may type a question using the Q&A box located in the bottom center of your screen, directly underneath the PPT slide.

30. Continuing Education Information • One Category 1 CEPTC credit is being offered for this webinar as well as a Certificate of Attendance • Must fill out the evaluation form; the link for the evaluation form will be sent to you via email in the next 48 hours • Will receive a certificate via email within one week • Group Leaders - Please keep a copy of your contact information sheet to track the names of the participants. You do not need to send in the contact sheet

31. 2014 Transplant Thank you! For more information: Karen Libs klibs@odt-alliance.org This webinar was made possible by Grant Number UD2HS22186 from the Division of Transplantation, Health Resources and Services Administration, U.S. Department of Health and Human Services