116.3: From 47 to 82 donors per million: from a successful initiative to a sustainable culture of best practice in organ donation.

Abstract

Background: Practice and results vary widely between hospitals, and even within health systems. An Initiative was begun in 2015 to eliminate variability and standardize practices across 8 hospitals serving a population of approximately 967,000. Included are two transplant centers and two level one trauma centers representing combined donor potential of 120 in 2018. Methods: Historic HD strategy encompassed proactive, comprehensive education, routine case follow up, relationship building practices, multidisciplinary Donation Councils, committee presentations and access to senior administration and physician practice groups at each hospital. Ten years of data showed an average conversion rate of 57%. In 2015 the OPO partnered with various state professional organizations, each health system, and the state department of health to “Create and Sustain a Culture Where Optimal Donation Practices and Collaboration Are Embraced, Resulting in a Sustained Organ Donation Rate of At Least 65%”. Efforts focused on timely referral, and planned and collaborative family conversations about donation, driven by leadership engagement. A core group of approximately 50 multidisciplinary clinicians and administrators implement a concentrated, multi-faceted approach to improvement and adoption of best practices. They attained a 62% conversion rate and 61 donors per million (DPM). In 2017 and 2018 as successes were attained, the work group turned its attention to direct engagement and empowerment of bedside staff. After a brief period of norming, the conversion rate rose to 65% in 2018, with 82 DPM, and is continues to rise through the first quarter of 2019. Results: Though this process has involved periods of norming and adjustment, the OPO’s process of top-down engagement of hospital teams has yielded unprecedented results across various hospital systems. It demonstrates success as well as donation growth and sustainability. There have been unprecedented statewide increases in donation: achievement of a 73% conversion rate (vs 57%), and a steady, sustainable increase in identification and conversion of potential organ donors. Conclusions: A strategic, multi-faceted, and collaborative performance improvement initiative that creates shared accountability between the OPO, hospital leadership, and bedside staff, and implemented transparently through ongoing mutual critique and commitment to collaborative change amongst various healthcare systems, produces improved and sustainable results. Adherence to a single set of best practices across all hospitals will raise donation rates, and thoughtful, fluid approaches to educate and motivate staff can sustain those outcomes.