1. After Action Reviews Making one of the “First Things First” work for you. Gary Burris, RN, MBA, CPTC Director of Operations LifeShare Of The Carolinas

2. Background Collaborative Partner: Carolinas Medical Center Charlotte, NC 800 – bed Level I Trauma Center Annual Donor Potential ~ 70-75 Struggled with Collaborative I Conversion Rate in 2004 = 38% Re-invested in Collaborative II

3. 2005 – Success Story - almost Re-invested in Collaborative II Embraced “First Things First” –In House Coordinator –Data Data Data –↑ Physician Champions –Death Record Reviews –Relentless Pursuit of Triggers –Huddles –Effective Requesters –After Action Reviews Adopted the HLC’s –Mission –Senior Leadership –OPO/Hospital Team –Early Referral/Rapid Response –Effective Requesting –DCD

4. 2005 – Success Story - almost After Action Reviews – room for improvement –Hospital driven. –EVERY approach gets a review. –Within 3 days of the approach. –Scheduled by the nurse manager. –Includes nsg. staff that was involved and anyone else. –Multidisciplinary - RT, SW, OR, Pt/Family Svs etc. –Take notes, look for trends, take actions, (a continuous PDSA) –Report to Collaborative Team Leadership

5. After Action Review - making it happen OPO Family Support Coordinator sends email to AVP AVP contacts unit manager to schedule the AAR and then sends meeting planner to invitees: –Chaplains, Resp Therapy, LifeShare, Pt/Family Services, Social Work, OR, ED, Senior Administration, Med. Center Air, AAR is held at a time that is convenient for the nursing unit. Key players are expected to be there.

6. After Action Review - how it happens Key players sit at the table (fish bowl) LifeShare FSC tells “the whole story” Each representative tells their side. Specific “standards” are evaluated as the story unfolds

7. After Action Review - how it happens Was Family support activated within one hour of the Clinical Trigger’s being met? Did the proper individuals respond timely? Did the Communication Log reflect donation support? Did the specified Huddles take place? Was the “Effective Request Process” used? Was there a “Reapproach” if applicable? Summary –What worked well? –What opportunities exists? –__________________

8. After Action Review - how it happens Goal - everyone leaves with “take aways” Issues that can be resolved at the meeting are resolved. Issues that need to be referred to others are done so immediately. Changes are communicated throughout the System and at each AAR. Summary reports are shared monthly for the Organ Donation Steering Committee oversight.

9. After Action Review – has it made a difference 2004 - Conversion Rate = 38% 23 donors 2005 - Conversion Rate = 65% 46 donors2005 - Conversion Rate = 65% 46 donors

10. AFTER ACTION REVIEW Date: ________Time: _________Location: _________________ Name:______________ Hx #___________ Admission date/Time: ___________ Admit diagnosis: __________________________________________________ Time Clinical Triggers Met:_______ Time of referral: ______ Referred by:_______ Summary: _________________________________________________________ ___________________________________________________________________ What made the case work well? _____________________________________________________________ What are areas of improvement? ________________________________________________________________ Does anyone have any concerns? __________________________________________________________________ Actions:___________________________________________________________ What organs were recovered/Transplanted? ________________________