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Process Improvement in Thoracic Organ Donor Retrieval: Implementation of a Donor Assessment Checklist
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The Journal of Heart and Lung Transplantation, Vol 32, No 4S, April 2014
FVC% (r= -.31, p= .005) and DLCO% (r= -.23, p= .04). Donor s-creatinine was correlated with 6MWT (r= .25, p= .05) and DLCO% (r= .41, p= .0007). This remained significant when controlling for donor height or weight. Notably, recipients receiving lungs from donors with gas exchange < 300 mmHg (n= 25) had no significant difference in 6MWT (Δ = 15 m, p= .64), DLCO% (Δ = 0, p= .92), FEV1% (Δ = -7%, p= .26), FVC (Δ = 0 , p= .99) or FEV/FVC (Δ = -6%, p= .11). Conclusion: The following donor factors were associated with inferior lung function in the recipients one year post-transplant: age > 55 years, female gender, smoking history, time on ventilator, BMI > 25 and low s-creatinine.
7( 38) High Emergency Lung Transplantation: The Experience of a French Centre L. Beaumont ,1 E. Sage,2 F. Parquin,2 D. Grenet,1 S. De Miranda,1 A. Hamid,1 C. Picard,1 M. Fischler,3 C. Cerf,4 M. Stern,1 A. Roux.1 1Department of Pneumology, Foch Hospital, Suresnes, France; 2Department of Thoracic Surgery, Foch Hospital, Suresnes, France; 3Department of Anesthesiology, Foch Hospital, Suresnes, France; 4Department of Reanimation, Foch Hospital, Suresnes, France. Purpose: Numerous candidates to lung transplantation (LT) still died on waiting list, asking the question of graft availability and organ allocation. In France, a national priority called High Emergency LT (HELT) has been defined in 2007 to favour allocation of organs to patients with a high and short term risk of death. We report the experience of HELT since its implementation in our centre. Methods: From 1st July 2007 to 31th May 2012, 201 patients (38 HELT, 163 classic LT) have received LT. Results: Pre LT primary diagnosis was in HELT and classic LT patients respectively: Cystic Fibrosis (81.1 vs 48, 7 %), Interstitial Lung disease (16.2 vs 15, 2 %) and Emphysema (0 vs 27, 4 %). HELT candidates had a significantly higher impairment grade on respiratory and hemodynamic status and higher LAS. HELT patients had a higher incidence of peroperative complications such as extracorporeal circulatory assistance (75% vs 36.6%, p= 0.0005), peroperative bleeding. No significant difference was observed in term of mechanical ventilation duration (15.5d vs 11d, p= 0.27), ICU length of stay (15d. vs 10d, p= 0.22), total length of stay (37d vs 28d, p= 0.15) and survival rate at 6, 12, 24 months post LT. Conclusion: In our experience, HELT provided similar survival rates than classic LT despite a more severe clinical status of the candidates on waiting
list. Such results are associated with a dramatic reduction of our mortality rate of patient on the waiting list. 7( 39) Process Improvement in Thoracic Organ Donor Retrieval: Implementation of a Donor Assessment Checklist G. Loor ,1 G. Weide,1 S. Keshavamurthy,2 S. Hussain,2 D. Topalidis,1 M. Alsalihi,2 K. McCurry,2 C. Koch.2 1University of Minnesota Medical Center, Minneapolis, MN; 2Cleveland Clinic, Cleveland, OH. Purpose: Onsite donor assessment is the final checkpoint before committing to heart or lung transplantation. This process often occurs in an unfamiliar environment, in off-hours and is often led by junior members of the transplant team. Our primary objective was to develop and implement a formalized checklist to reduce untoward events related to donor identification, organ compatibility, and organ quality. Methods: Eight procurement fellows were included in the study across 2 major transplant centers in the US. Prior to checklist implementation 10 procurements at each institution were retrospectively reviewed for adverse events. Checklist development involved multidisciplinary teams and centered on areas of patient identifiers, compatibility, organ quality and team readiness. Educational in-services were held at each institution on use of the checklist as well as best organ assessment practices. Two hard stops were added to the procurement process: one prior to making the skin incision and the other prior to administering heparin. We surveyed the procurement fellows with a series of questions on ease of use and satisfaction with the checklist process. Results: Nine untoward events were reported in 20 procurements prior to the use of the checklist. Most of these events were minor and none compromised the quality of the donor organ. One untoward event was reported after the checklist was instituted. 40 procurements (20 from each institution) utilized the checklist with 100% compliance. At least 20 near miss events related to donor documentation, donor management, organ quality and team readiness were prevented by the checklist. 87% of fellows found the checklist to be unobtrusive to work flow, 100% felt the checklist should be mandatory, 75% felt it significantly added to the consistency of the assessment process and 100% found that it improved orderliness of procurement. Conclusion: The donor assessment process is replete with near misses and/ or untoward events. A checklist process with a firm time out prior to organ retrieval is unobtrusive and effective in preventing near-miss events. We recommend that a donor assessment checklist be part of all thoracic organ procurements. 7( 40) A Single Center Experience in the Use of Eurotransplant Donor Scoring on Donor Lung Utilization E. Mahoney ,1 D. Dilling,2 J. Schwartz,3 E. Lowery.2 1Loyola University Medical Center, Maywood, IL; 2Pulmonary and Critical Care Medicine, Loyola University Medical Center, Maywood, IL; 3Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL. Purpose: In the United States there continues to be a disparity between the number of patients with pulmonary disease waiting for lung transplant and the number of suitable organs for transplant. The utilization of alternative options to expand the donor poll with the use of donation after cardiac death remains low and ex-vivo lung perfusion is still investigational. A scoring system originally developed by Oto et al. from the Melbourne group was expanded by Eurotransplant in the hopes of quantifying donor risk characteristics to enable improved evaluation of donor acceptability. The donor score consists of age, social history, smoking history, chest x-ray findings, bronchoscopy results, and arterial blood gas. In this investigation, our center implemented the Eurotransplant scoring system in all lung donor offered to assess impact on donor lung utilization rates. Methods: Donors were scored during the evaluation process over one year and the scores presented to evaluating physicians and surgeons. Acceptance rates and subsequent transplants by donor score were then compared by doing retrospective scoring of the previous year. Results: Prior to implementation, we accepted 44 out of 341 total lung donors as suitable, with only 1% of total offers proceeding to transplant. Following
The Journal of Heart and Lung Transplantation, Vol 32, No 4S, April 2014
FVC% (r= -.31, p= .005) and DLCO% (r= -.23, p= .04). Donor s-creatinine was correlated with 6MWT (r= .25, p= .05) and DLCO% (r= .41, p= .0007). This remained significant when controlling for donor height or weight. Notably, recipients receiving lungs from donors with gas exchange < 300 mmHg (n= 25) had no significant difference in 6MWT (Δ = 15 m, p= .64), DLCO% (Δ = 0, p= .92), FEV1% (Δ = -7%, p= .26), FVC (Δ = 0 , p= .99) or FEV/FVC (Δ = -6%, p= .11). Conclusion: The following donor factors were associated with inferior lung function in the recipients one year post-transplant: age > 55 years, female gender, smoking history, time on ventilator, BMI > 25 and low s-creatinine.
7( 38) High Emergency Lung Transplantation: The Experience of a French Centre L. Beaumont ,1 E. Sage,2 F. Parquin,2 D. Grenet,1 S. De Miranda,1 A. Hamid,1 C. Picard,1 M. Fischler,3 C. Cerf,4 M. Stern,1 A. Roux.1 1Department of Pneumology, Foch Hospital, Suresnes, France; 2Department of Thoracic Surgery, Foch Hospital, Suresnes, France; 3Department of Anesthesiology, Foch Hospital, Suresnes, France; 4Department of Reanimation, Foch Hospital, Suresnes, France. Purpose: Numerous candidates to lung transplantation (LT) still died on waiting list, asking the question of graft availability and organ allocation. In France, a national priority called High Emergency LT (HELT) has been defined in 2007 to favour allocation of organs to patients with a high and short term risk of death. We report the experience of HELT since its implementation in our centre. Methods: From 1st July 2007 to 31th May 2012, 201 patients (38 HELT, 163 classic LT) have received LT. Results: Pre LT primary diagnosis was in HELT and classic LT patients respectively: Cystic Fibrosis (81.1 vs 48, 7 %), Interstitial Lung disease (16.2 vs 15, 2 %) and Emphysema (0 vs 27, 4 %). HELT candidates had a significantly higher impairment grade on respiratory and hemodynamic status and higher LAS. HELT patients had a higher incidence of peroperative complications such as extracorporeal circulatory assistance (75% vs 36.6%, p= 0.0005), peroperative bleeding. No significant difference was observed in term of mechanical ventilation duration (15.5d vs 11d, p= 0.27), ICU length of stay (15d. vs 10d, p= 0.22), total length of stay (37d vs 28d, p= 0.15) and survival rate at 6, 12, 24 months post LT. Conclusion: In our experience, HELT provided similar survival rates than classic LT despite a more severe clinical status of the candidates on waiting
list. Such results are associated with a dramatic reduction of our mortality rate of patient on the waiting list. 7( 39) Process Improvement in Thoracic Organ Donor Retrieval: Implementation of a Donor Assessment Checklist G. Loor ,1 G. Weide,1 S. Keshavamurthy,2 S. Hussain,2 D. Topalidis,1 M. Alsalihi,2 K. McCurry,2 C. Koch.2 1University of Minnesota Medical Center, Minneapolis, MN; 2Cleveland Clinic, Cleveland, OH. Purpose: Onsite donor assessment is the final checkpoint before committing to heart or lung transplantation. This process often occurs in an unfamiliar environment, in off-hours and is often led by junior members of the transplant team. Our primary objective was to develop and implement a formalized checklist to reduce untoward events related to donor identification, organ compatibility, and organ quality. Methods: Eight procurement fellows were included in the study across 2 major transplant centers in the US. Prior to checklist implementation 10 procurements at each institution were retrospectively reviewed for adverse events. Checklist development involved multidisciplinary teams and centered on areas of patient identifiers, compatibility, organ quality and team readiness. Educational in-services were held at each institution on use of the checklist as well as best organ assessment practices. Two hard stops were added to the procurement process: one prior to making the skin incision and the other prior to administering heparin. We surveyed the procurement fellows with a series of questions on ease of use and satisfaction with the checklist process. Results: Nine untoward events were reported in 20 procurements prior to the use of the checklist. Most of these events were minor and none compromised the quality of the donor organ. One untoward event was reported after the checklist was instituted. 40 procurements (20 from each institution) utilized the checklist with 100% compliance. At least 20 near miss events related to donor documentation, donor management, organ quality and team readiness were prevented by the checklist. 87% of fellows found the checklist to be unobtrusive to work flow, 100% felt the checklist should be mandatory, 75% felt it significantly added to the consistency of the assessment process and 100% found that it improved orderliness of procurement. Conclusion: The donor assessment process is replete with near misses and/ or untoward events. A checklist process with a firm time out prior to organ retrieval is unobtrusive and effective in preventing near-miss events. We recommend that a donor assessment checklist be part of all thoracic organ procurements. 7( 40) A Single Center Experience in the Use of Eurotransplant Donor Scoring on Donor Lung Utilization E. Mahoney ,1 D. Dilling,2 J. Schwartz,3 E. Lowery.2 1Loyola University Medical Center, Maywood, IL; 2Pulmonary and Critical Care Medicine, Loyola University Medical Center, Maywood, IL; 3Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL. Purpose: In the United States there continues to be a disparity between the number of patients with pulmonary disease waiting for lung transplant and the number of suitable organs for transplant. The utilization of alternative options to expand the donor poll with the use of donation after cardiac death remains low and ex-vivo lung perfusion is still investigational. A scoring system originally developed by Oto et al. from the Melbourne group was expanded by Eurotransplant in the hopes of quantifying donor risk characteristics to enable improved evaluation of donor acceptability. The donor score consists of age, social history, smoking history, chest x-ray findings, bronchoscopy results, and arterial blood gas. In this investigation, our center implemented the Eurotransplant scoring system in all lung donor offered to assess impact on donor lung utilization rates. Methods: Donors were scored during the evaluation process over one year and the scores presented to evaluating physicians and surgeons. Acceptance rates and subsequent transplants by donor score were then compared by doing retrospective scoring of the previous year. Results: Prior to implementation, we accepted 44 out of 341 total lung donors as suitable, with only 1% of total offers proceeding to transplant. Following