A PERIOPERATIVE MULTI-DISCIPLINARY TEAM EFFORT IN IMPROVING HEART AND MULTIORGAN TRANSPLANT SURVIVAL WHEN COMPARED TO THE NATIONAL STANDARDS

Abstract

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: Coordinated patient-centered care is a focus of quality measures and is associated with improved patient outcomes. A structured multidisciplinary curriculum may include morning rounds, comprehensive workflows, and follow-up care. The extent to which these protocols are implemented varies across healthcare setups. Here, we summarize how a tertiary care center’s perioperative multi-disciplinary approach improved outcomes in organ transplant patients, which are one of the most challenging surgical cohorts of patients in the field of medicine. METHODS: This study was conducted in a tertiary care academic medical center. Permission was obtained from the System Quality & Patient Safety and Quality Operations departments for the use of data. A multidisciplinary approach was used, and several interventions were planned and implemented. The Policy and Procedure manual was reviewed and updated. A multi-disciplinary team comprising surgeons, intensivists, heart failure group, nurses, and respiratory therapists was constituted. Detailed workflows with pre-operative, intraoperative, and post-operative care were established. Fast track extubation and early mobilization protocols were set in place. Early morning rounds with nurses, the heart failure team, attending physicians, pharmacists, and cardiac rehabilitation technicians were conducted to discuss the status and mobilization plan for each patient. RESULTS: 1-year patient survival for heart transplants was 93.44% when compared to the national benchmark of 91.67%. 1-year primary VAD implant survival was at 96.8% when compared to national survival of 84.6%. The recent Scientific Registry of Transplant Recipients (SRTR) report demonstrated that the survival trend at our center improved further for multi-organ transplants. 5 heart-lung transplants had a 100% survival when compared to 83% national survival. 19 heart-kidney had 95% survival when compared to 88% national survival. 100% survival was noticed amongst 15 heart-liver transplants when compared to the 88% national benchmark. CONCLUSIONS: Our results highlight the invaluable role of a patient-centered interprofessional team in improving patient outcomes. Transplant patients have time-sensitive needs. A proactive multimodal approach can facilitate early detection and optimal management of complications and therefore speed up the recovery process in post-surgical patients. CLINICAL IMPLICATIONS: A perioperative multidisciplinary team approach can improve patient morbidity and mortality in complex organ transplant patients. This approach can be augmented by implementing standardized protocols to maintain adequate patient care thereby decreasing the length of hospital stay and healthcare costs. While the multidisciplinary rounds are becoming a common practice, not all institutions have processes and procedures in place to help maintain continued care after surgery. DISCLOSURES: No relevant relationships by Sahar Fatima, source=Web Response No relevant relationships by Gaurav Gheewala, source=Web Response No relevant relationships by FAISAL MASUD, source=Web Response No relevant relationships by Ariba Naz, source=Web Response No relevant relationships by Iqbal Ratnani, source=Web Response