1. Seattle Children’s Hospital
Transplant QAPI at
Seattle Children’s Hospital
Kathy Jo Freeman, RN, MSN
Director, Transplant Service Line
Seattle Children’s Hospital
October 3, 2013

2. “Not everything that can be counted counts, and not everything that counts can be counted.”
Sign hanging in Einstein’s office at Princeton

3. Transplant Quality
QAPI Plan
The Transplant Quality Assessment and Performance Improvement (QAPI) program oversees the overall quality management of the three phases of solid organ transplantation. Through continuous QAPI efforts, patient processes and outcomes will be measured and improved.

4. Continuous Process Improvement
QAPI Methods
Continuous Process Improvement
Plan Do
Check
Act
Based on the Toyota Production System (TPS)

5. Transplant Quality Committee
Organizational Structure
Board of Trustees
Quality Improvement Steering Committee
Transplant Quality Committee
Transplant Team
Front Line Staff

6. Transplant Quality
Process
One outcome and one process measure is defined for each organ in each phase of transplantation (pre, txp & post)
A target is set for each metric
Data definitions are developed for each metric
Data is collected and reported
Results are tracked and trended over time
Actions are defined and taken
Data is re-measured

7. Pediatric intestinal and/or multivisceral
Metrics Grid
Pediatric Kidney
Transplant Activities/ Process
Metrics/ Benchmarks
Patient Outcomes
Metrics/Benchmarks
Pre-transplant
SW assessment with psychosocial risks conversation evaluation
Compliance with CMS Tag X164 / 95%
Immunization selection & 90 days > selection
Selection 66%
>90 days
Transplant
ABO verification in OR
100%
Length of Stay
10% reduction based on FY13 data
Post-transplant
Stent Removal
Division protocol 100%
Early rejection (6 mo)
10-30%
Pediatric Liver
Nutrition assessment documented prior to listing
Compliance with CMS Tag X094 / 95%
Active Wait Time, listing to transplant
10% reduction based on FY12-FY13 data
Unplanned returns to OR (7 days)
<20%
Viral surveillance
Division protocol 90%
15-40%
Pediatric Heart
Pharmacy assessment documented prior to listing
Compliance with CMS Tag X082 / 95%
WL removal too sick for transplant
10%
Unplanned returns to OR / Cardiac Cath Intervention (30 days)
Pediatric intestinal and/or multivisceral
SRTR update (bi-yearly) letters saved to patient EMR
Compliance with CMS Tag X155 / 95%
0-40%

8. Data Definition Worksheet

9. Process Improvement

10. Overall Learnings
Leadership, ownership, and accountability are key
“if everyone is responsible, no one is responsible”
Define metrics that are meaningful, actionable and measurable
Do not try to measure everything– be intentional

11. Overall Successes and Challenges
Data collection has become part of our routine
Regular reports on QAPI have increased team involvement
Program is robust and a key focus of our work
Challenges
Metrics are difficult to define
Data collection is cumbersome and mostly manual