1. Donation Best Practice: “HUDDLES” Pat McCabe, RN Clinical Specialist Washington Hospital Center & Inova Fairfax Hospital Presentation Questions? elizabeth@wrtc.org Elizabeth Spencer Washington Regional Transplant Consortium

2. Discussion Plan Why “Huddle”? Benefits to:  Hospital  OPO  Families Steps for Implementation

3. Why “Huddle?” To coordinate processes for best possible donation outcomes every time To build OPO-hospital partnerships To develop & utilize hospital-based champions to create a better donation process To reach the goals of the Collaboratives  Increase Authorization/Conversion Rates & OTPD

4. Benefits of Huddling to the Hospital… Sharing OPO assessment of potential options, & developing a joint game plan, increases hospital staff comfort level with donation approach  Helps guide medical preservation of those potential options  Provides staff with tools (i.e. resources, language, etc.) Results in increased comfort with OPO Coordinators & OPO good intentions  Further solidifies OPO access & OPO-hospital staff partnership Leadership roles within institution as “Donation Champion” Hospital partners become participants in the donation process  Witness & assist in something positive from something otherwise only negative

5. Benefits of Huddling to OPO… Fostering vested interest in outcome/ joint accountability with hospital partners. Joint accountability for better outcomes. OPO team in the loop on hospital’s care plan Better ability to “follow” patient & anticipate needs More focused pre- brain death care Putting donation on the radar of caregivers  Medical “preservation of the donation option” (reduce # of NMS/PC)  Grave prognosis preparation (reduce # of times OPO coordinator approaches families who don’t really “get” brain death) Internal help in problem-solving Identification of appropriate staff to accompany OPO requestors Assistance from an “insider” in more effectively addressing barriers (Timeliness of testing, suitability info, OR scheduling, etc.)

6. Benefits of Huddling to the Family… The Old Days: Hospital to OPO “Pass Off”  Did the family really benefit from this strict separation?  Donation could have been seen as a scary thing from which the hospital caregivers must be disassociated Huddles → Unified Game Plan → Continuity of Care for the grieving family  Donation as a positive part of the care continuum  Consistency in information discussed OPO knows what the hospital knows & can reinforce message

7. Getting Started. First Steps: Identify potential Huddle participants Preparation & maintenance Make “user friendly” for OPO Coordinators & hospital participants

8. Identify Huddle Participants  Core Hospital Key Players: Attending Physician and/or Intensivist Resident Bedside Nurse Charge Nurse  Add’l Hospital Staff based on structure & needs: Soc Work, Pastoral Care, Case Management Donation Cmte members: PI, OR administration, Clin Spec, etc.  OPO: On-site Coordinator Medical Director Hospital Development/Services and/or Administrator-On-Call

9. Preparation & Maintenance  Educate key players beforehand & in real-time Purpose Process Benefits  Mock Huddle Scenarios  Keep huddles brief & to-the-point with manageable # of participants  Maintain consistency: Expectation of a Huddle every time & response from all planned participants.

10. Make “User friendly” This is yet another process in the hectic lives of the OPO Coordinators & hospital staff  “Marketing:” Ease & Benefits  Opportunity for process feedback & improvements OPO: Develop & distribute hospital-specific contact plans for Coordinators/HD  Remove ambiguity about hospital-specific process differences  Clear outline of agreed-upon expectations (timing, participants) & participant contact information  WRTC: Organ Recovery Staff HD Resource Utilize a template as a guide for Huddle discussion topics

11. Why You Should Huddle… Increase the ability of the approach team to work effectively with families. Create an atmosphere of teamwork to fix problems/dissolve barriers. Foster partnership between hospital & OPO colleagues. Develop sense of joint accountability for donation outcomes. Creating an “All-About-the-Ones” attitude! Some cases, that wouldn’t have converted, will. Some organs, that wouldn’t have been transplanted, will be.

12. Questions?