1. 800-DONORS-7 core.org Process Breakdown Analysis and Improvement Kate Zetler, CORE

2. 800-DONORS-7 core.org CORE DSA A Snapshot 155 Hospitals 5 Transplant Centers 13 Trauma Centers (Levels1 &2 ) 1 Free-Standing Pediatric Hospital

3. 800-DONORS-7 core.org Process Breakdowns 1 st -3 rd Quarter

4. 800-DONORS-7 core.org First Three Quarters by the numbers… Ruh- Roh!

5. 800-DONORS-7 core.org PBD Totals by Hospitals with 10+ PBDs

6. 800-DONORS-7 core.org 4 th Quarter Action Plan AGENDA: To reduce Process Breakdowns (timeliness of referrals*) by 60% before year end 2012. Action Steps: - Responsibility will be of the individual PSLs Timeline: - September 1 – December 31, an analysis and interventions Resources: - Modified and uniform presentations to deliver to hospital staff in-services - Implementation of regular use of clinical trigger cards to be distributed when rounding, in-services, any education opportunities. -Immediate follow-up (within 24hrs) with key contacts at hospitals when an “Untimely Referral” is made. - Dashboard used to reinforce Process Measures at individual hospitals - Straight-forward definitions of a “Process Breakdown” - Follow up with attending physician within 24 hours of donor case - Increase of PSL availability on the units to develop relationships.

7. 800-DONORS-7 core.org Specific Area for Improvement Effective Request Children’s Hospital of Pittsburgh –Large level one trauma center, only free standing children’s hospital in the region. –Current issues with early mention to families from previous designated requestors and other CCMs –Escalated in 2012, resulting in poor conversion rate through the 3 rd quarter (52.3%Effective Request) –Something had to be done

8. 800-DONORS-7 core.org Seed Statements & Effective Request A way for the physicians to become involved… –We wanted the CCMs to be involved in the approach, but not before a huddle process and discussion of the options –CCMs wanted to be able to give the family a “Heads up” that another discussion was coming Part of the issue between this hospital and CORE was the feeling that CORE was trying to “take care away” from the medical team.

9. 800-DONORS-7 core.org What we did… Multiple meetings between Director of Professional Services and professional service liaison with “repeat offenders” Met after every early mention Discussed the use of “Seed Statements” difficult situations Some acknowledgement by the hospital that early mention hurt the donation conversation.

10. 800-DONORS-7 core.org Bold Requests in Action! Bold Requests from Children’s Hospital DAG 1. Need for more consistent communication/ more inclusive huddle between OPC and CHP staff. “Star Contact” Initiated –Nursing Supervisor to be contacted as soon as the OPC arrived on- site –Nursing Supervisor responsible for gathering Huddle Team and meeting in a “safe place” to discuss donation steps

11. 800-DONORS-7 core.org Bold Requests in Action! Bold Requests from Children’s DAG 2. CHP recognized that virtually none of our OPC staff ever worked in pediatrics, less than half were nurses. –CHP offered a “Welcome to Pediatrics” course for OPC staff to attend to learn about the difference between care of adults and pediatrics –CHP staff felt that we finally “heard them out”, OPC staff had a better understanding of the pediatrics healthcare team

12. 800-DONORS-7 core.org CHP Results!

13. 800-DONORS-7 core.org DSA Results… 3 rd Quarter 4 th Quarter Type of PBDNumber of Body Released6 Communication4 Funeral Home16 Hospital Approach23 Physician2 No Call Prior to Ext.4 Untimely Referral (over all) 252 Total307 Type of PBDNumber of Body Released6 Communication6 Funeral Home4 Hospital Approach19 Physician1 No Call Prior to Ext.5 Untimely Referral (over all) 168 Total204 33% Decrease

14. 800-DONORS-7 core.org Moving Forward How can the hospital’s own this? How do we shift donation to a “hospital led program”?

15. 800-DONORS-7 core.org Community of Practice Council New to the HD Department –Weekly Pull Call New Ideas from the 2-29 meeting –Clinical Trigger Cards for specific units (MICU vs. CICU vs. TICU) –System Wide interventions and DAG –Process Breakdown Audit Tool

16. 800-DONORS-7 core.org Thank you!