ACCORD Mark Roberts ACCORD Business Lead

Achieving Comprehensive Coordination in ORgan Donation EU funded Joint Action Joint Action led and coordinated by ONT 6 work packages NHSBT lead on Work Package 5 15 EU countries participating in WP5 3 Year project

Work Package 5 ‘strengthen the relationship between intensive care units and donor co-ordinators for the purpose of reaching the full potential of deceased donation in each participating Member State’

Aims Analyse end of life practices for patients with a devastating head injury across Europe and the impact on organ donation Provide a improvement methodology toolkit for strengthening co-operation between ICUs and DTC

Deliverables Establish a Clinical Reference Group Report on the study of the variations in end of life care pathways for patients with devastating brain injury in Europe

Deliverables Recommendations to achieve improvements in end of life care pathways to promote organ donation Report on the effectiveness of the improvement methodologies in achieving increases in organ donation

Methodology Each MS has appointed 2 hospitals to participate in the project Stage 1 – Variations in end of life care Country Questionnaire Hospital Questionnaire Patient Questionnaire

Methodology Stage 1 – Variation in care pathways Data is analysed by WP5 team to develop a report showing variation in practice Stage 2 - Evaluation Identification of potential barriers to donation

Methodology Stage 3 – Improvement Model implementation Training an expert in each participating MS in the improvement methodology (PDSA cycles) Each hospital undertakes a short project Collect further data to monitor

Methodology Stage 4 – final report Data from study and learning from PDSA cycles will be collated and reported

Questionnaires 6 Months data collection (Mar 13-Aug13) 67 hospital questionnaires submitted 66 hospitals submitted patient data 1670 patient questionnaires submitted 513 from UK hospitals

Country Questionnaire

A legal definition for brain death/cardio-respiratory death Professional guidance/standards/codes of practice National independent ethical codes of practice Guidance on the withdrawal or limitation of treatment Training for healthcare professionals A national organisation responsible for organ donation A regulatory body that has oversight of organ donation National indicators for organ donation

Hospital Questionnaire 1. Number of staffed beds in your hospital where you can mechanically ventilate a critically ill patient. 2. Does your hospital have neurosurgical facilities on site? 3. Does your hospital have interventional neuroradiology facilities on site? 4. Does your hospital perform solid organ transplants? 5. Is your hospital a designated trauma centre? 6. Number of actual organ donors in your hospital in What is the availability of the Key Donation Person within your hospital?

Hospital Questionnaire 8. What is the clinical background of your hospital's Key Donation Person or if you have a team what is the clinical background of the Team Leader? 9. Does your hospital have a written local policy/guideline/protocol for managing the organ donation process? 10. Does your hospital have written criteria of when to alert the key donation person of a potential organ donor? 11. Does your hospital have the ability to facilitate organ donation 24 hours a day with regards to the following resources? Resources: CT Scanner/ MRI Scanner/ HLA and virology testing/ Trans-Cranial Doppler/ EEG/ Cerebral angiography

Patient Questionnaire

Patient Questionnaire Design Q4 Intubated & Ventilated Q5 ? preconditions Q6 ? tested Q7 ? Brain dead Q8: ? Donation after Circulatory DeathQ9: ?referred to Key Donation PersonQ10: ? Family approached Q11: Who approached family? Q13. Did donation happen? STOP Q1, Q2 & Q3 General Qs…..

Number of patients audited by country

DBD pathway for ALL audited patients (n=1670)

DCD pathway for ALL audited patients (n=1670)

Care of the patient

DCD donation

Improvement Model

What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement ActPlan StudyDo Understanding the problem. Knowing what you’re trying to do - clear and desirable aims and objectives Measuring processes and outcomes What have others done? What ideas do we have? What can we learn as we go along? Langley G, Moen R, Nolan K, Nolan T, Norman C, Provost L, (2009), The Improvement Guide: a practical approach to enhancing organizational performance (2 nd ed), Josses Bass Publishers, San Francisco The Improvement Model

The PDSA Improvement Model Make change on a small scale Ensure it is - modifiable - realistic - measurable Engage with key stakeholders

The PDSA Improvement Model 66 participants from across Europe attended one of three training days held in London on the Improvement Model. WP5 Project Team have reviewed all the plans and reports PDSA cycles ran from November 2013 to April reports from 55 plans

Hospital PDSA Plans

Sustainability Develop a toolkit for use by other hospitals Widely disseminate Final Report and Toolkit Publish findings Present at EDTCO and NHSBT congress

Rory Collier Royal Berkshire Hospital United Kingdom

PDSA Cycle

Thank You