Waitlist Time Research Articles

Evaluating Access to Neuropsychological Services for Individuals With Spina Bifida: Insights From the 2022 Provider Survey

Background: Many people with spina bifida (SB) have congenital brain malformations and receive neurosurgical intervention that can impact cognitive, behavioral, and emotional functioning. The Spina Bifida Association's (SBA) guidelines for care recommend that people with SB have neuropsychology evaluations to assess cognitive, behavioral, and emotional functioning throughout their lifespan; however, people with SB anecdotally report having trouble finding and accessing such care. Objectives: The goal of this study was to gain information about neuropsychology services available to people with SB and identify possible barriers to care. Methods: Neuropsychologists in the United States were invited to complete a practice-focused survey created by members of the Spina Bifida Neuropsychology Collaborative (SBNC). The survey was emailed to professional neuropsychology listservs and directly to providers at the SBA Clinic Care Partner and National Spina Bifida Patient Registry (NSBPR) sites. Results: Responses from 34 neuropsychologists (representing 22 sites, including 40% of SBA Clinic Care Partner sites and 67% of NSBPR sites) indicated that multilingual SB-focused neuropsychology services are available within all regions of the United States. Comprehensive, outpatient evaluations are common; however, integration of neuropsychology services into inpatient settings and multidisciplinary clinics is limited. Respondents report that waitlist time is the most frequent barrier to neuropsychology care, followed by cost/insurance/payor type, travel/transportation difficulties, and limited referrals. Conclusion: There are considerable gaps in the currently available array of US-based neuropsychology services for individuals with SB. Neuropsychologists and SB clinical programs are encouraged to strategically increase availability of neuropsychological services and expand care options.

Improving the Prioritization of Heart Transplantation Candidates for Optimal Clinical Outcomes: A Narrative Review.

This narrative review evaluates the limitations of current heart transplantation allocation models, which prioritize medical urgency and waitlist time but fail to adequately predict long-term post-transplant outcomes. It aims to identify advanced metrics that can strengthen the prioritization framework while addressing persistent racial, geographic, and socioeconomic inequities in access to transplantation. Recent research indicates that incorporating frailty, nutritional status, immunological compatibility, and pulmonary hemodynamics into allocation frameworks can enhance the prediction of transplant outcomes. The growing use of mechanical circulatory support (MCS) as a bridge to transplantation provides stabilization for critically ill patients; however, disparities in access persist. Studies continue to emphasize the barriers faced by minority and pediatric populations, highlighting the need for expanded donor networks and improved matching criteria. This review highlights the necessity of shifting transplantation prioritization toward multidimensional candidate evaluations that consider both clinical complexity and long-term outcomes. Policy reforms aimed at addressing healthcare disparities and optimizing donor utilization are crucial for improving patient outcomes. Future research should focus on assessing the effectiveness of advanced allocation models, such as continuous distribution frameworks, to promote equitable and sustainable transplantation systems.

Impact of Normothermic Machine Perfusion on Liver Transplant Waitlist Times: A Single-Center Matched Cohort

Impact of Normothermic Machine Perfusion on Liver Transplant Waitlist Times: A Single-Center Matched Cohort

Amyloidosis and Heart Transplantation in a New Era.

The prognosis in patients with advanced cardiac amyloidosis (CA) remains poor. We sought to describe survival post heart transplantation (HT) in amyloid compared with non-amyloid recipients, highlight waitlist times within the new allocation system across three Organ Procurement and Transplantation Network (OPTN) regions, and describe multiorgan transplantation (MOT) in hereditary amyloidosis. This is a retrospective review of end-stage CA patients who underwent HT at Mayo Clinic from January 2007 to December 2020. Wait time was compared in the new versus old OPTN allocation era starting December 18, 2018 by Wilcoxon rank sum test. All-cause mortality for those with and without CA was compared using Kaplan-Meier estimates with log rank analysis, censoring December 16, 2022. Fifty-five patients with CA underwent HT between 2007 and 2020, 8 light chain amyloidosis (AL) (14.5%), 28 hereditary transthyretin (ATTRv) (50.9%), 17 wildtype transthyretin (ATTRwt) (30.9%), and 2 hereditary apolipoprotein A1 (AApoA1) amyloidosis patients (3.6%). No significant difference in overall survival post-transplant was seen in amyloid compared with non-amyloid (p = 0.816). Median time to HT was shorter in the new system, 45 days (IQR 24, 78) versus 174 days (IQR 76.5, 483.5), p = 0.006. There was a decline in MOT in hereditary amyloidosis over time with the concomitant rise in disease-targeted therapies. HT survival in CA patients was similar to non-amyloid patients. The new allocation system benefits this cohort with shorter wait times. There is less MOT in hereditary amyloidosis with increased utilization of disease-targeted therapy.

Waitlist Time, Age, and Social Vulnerability: Impact on the Survival Benefit of Deceased Donor Kidney Transplantation Versus Long-term Dialysis Among Patients With End-stage Renal Disease.

Waitlist Time, Age, and Social Vulnerability: Impact on the Survival Benefit of Deceased Donor Kidney Transplantation Versus Long-term Dialysis Among Patients With End-stage Renal Disease.

Review of Current Normothermic Regional Perfusion Practice in Pediatric Cardiac Donation.

Cardiac allotransplantation is the optimal treatment for end-stage heart failure. However, organ supply remains the principal issue impacting patients. Pediatric patients present unique challenges resulting in long wait-list times and increased mortality. Donation after circulatory death with normothermic regional perfusion represents a method to increase the number of available organs in this population. Multi-institutional expert consultation was sought to outline extant technical, ethical, and logistical issues with regard to normothermic regional perfusion cardiac donation techniques. Specific advantages in the pediatric population are highlighted, as well as technical considerations resulting in successful organ procurement. Utilization of donation after circulatory death organs following normothermic regional perfusion in the United States is increasing and offers advantages to the pediatric heart failure population. Ethical reservations both nationally and abroad persist, namely pertaining to cerebral blood flow. This has led to variation in perception and utilization of normothermic regional perfusion, contributing to a discrepancy between donor and recipient locations. Procurement techniques and variations are described, with introduction into program planning and protocol development. Training in technical aspects of the procedure is paramount for both the surgeon and support staff to construct a successful program, along with transparent protocols to mitigate ethical concerns. Normothermic regional perfusion is relevant following donation after cardiac death in the pediatric population. Ethical and technical challenges remain in concert with substantial domestic and international variation. Standardization of technique may serve to increase future use and increase the number of available hearts for transplant, reducing pediatric mortality.

Cardiac transplantation with increased-risk donors: Trends and clinical outcomes.

Orthotopic Heart transplantation (OHT) is a definitive treatment for patients with advanced heart failure. Despite available evidence, recipients and some clinicians remain hesitant to accept organs from Increased Risk Donors (IRD). This study aims to report trends in acceptance of donors from IRD donors and long-term outcomes. This study is an analysis of OHT recipients captured in the United Network of Organ Sharing (UNOS) registry from 2004 to 2021. OHT recipients were dichotomized by IRD status. Primary objectives were to report survival following OHT and trends in IRD use. Secondary objectives included all-cause hospitalizations, hospitalizations for infection, treated rejection, and graft failure. Of the 36,989 OHT recipients within the study period, 7779 (21%) were identified as recipients of IRD. Recipients of IRD were older (57years vs 56years, p≤0.001), more likely to be African American (23% vs 21%, p=0.006), blood group O (40% vs 38%, p=0.02), have public insurance (52% vs 50%, p=0.02), and have a BMI >30 (30% vs 29%, p=0.003). IRD recipients had shorter waitlist time (69days vs 76days, p=0.009) and similar long-term survival. IRD recipients also had lower odds of rehospitalization due to infection (OR 0.893, CI 0.842-0.947; p=0.0002) and lower odds of rehospitalization due to rejection (OR 0.849, CI 0.782-0.921; p≤0.001). In this large multicenter study, we report that recipients of IRD had similar long-term survival and incidence of graft failure as recipients of standard risk donors. Further analysis is needed to understand observed differences in outcomes of hospitalizations for infection and treated rejection.

Optimizing parenting and child outcomes following parent–child interaction therapy – toddler: a randomized controlled trial

BackgroundParent–Child Interaction Therapy—Toddler (PCIT-T) is an attachment-informed intervention model designed to meet the specific developmental needs of toddlers aged 12–24 months presenting with challenging behaviors.MethodsThis study used a randomized controlled design to evaluate outcomes of PCIT-T for children aged 14–24 months with disruptive behaviors. Ninety toddlers with parent-reported disruptive behavior were randomly allocated to PCIT-T (intervention), an active control condition (Circle of Security– Parenting™; COS-P), or a non-treatment control condition (wait-list; WL). Outcomes were assessed at baseline (Time 1), post treatment/post waitlist (Time 2) and 4-month follow-up (Time 3).ResultsAt follow-up, the PCIT-T group displayed the highest levels of parenting sensitivity and positive parental verbalizations, and the lowest levels of negative child-directed verbalizations and non-attuned mind-minded statements. Of the three groups, the PCIT-T group showed the greatest degree of change on these variables, followed by the COS-P group and then the non-treated controls. The PCIT-T group were also the only group to show significant within-group improvements in sensitivity, self-reported parental reflectiveness, empathy and emotional understanding, parent-reported child social competence, child internalizing problems, and general behavior issues. Significant reductions in parental stress, child externalizing behaviors and parenting behaviors were seen for both the PCIT-T and COS-P groups.ConclusionsDelivered in the early intervention period of toddlerhood, Parent–Child Interaction Therapy—Toddler has the potential to bring about significant changes for children presenting with early onset behavioral issues.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR), 12,618,001,554,257. Registered 24 September 2018 – retrospectively registered, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001554257.

Reducing Wait Times in Child and Adolescent Ambulatory Mental Health: A Lean Six Sigma Process Improvement Study.

Suicide remains a leading cause of death for youth nationally, with access to mental health care continuing to be an emergent care imperative for health care organizations that are struggling to triage and provide critically needed mental health services to the communities they serve. Administrative inefficiencies present a potentially life-threatening delay in access to children seeking mental health care. Health care organizations have successfully used evidence-based process improvement methodologies to improve efficiency and reduce waste, including the Lean Six Sigma methodology. This study highlights the successful use of Lean Six Sigma to create an ambulatory scheduling process that significantly reduced waitlist times and increased timeliness of access to mental health care in a large pediatric hospital.

Use of Hepatitis C Viremic Donors to Expand the Pediatric Donor Pool.

The use of hepatitis C virus (HCV)-positive donors in organ transplantation has become increasingly viable due to advancements in direct-acting antiviral (DAA) therapies, which offer high cure rates. This review aims to evaluate the current practices, benefits, and challenges of utilizing HCV-positive donors for organ transplantation. The recent data show that transplant centers are progressively accepting HCV-positive donors for various organs, including kidneys, livers, and hearts, given the efficacy of post-transplant antiviral treatment. Using these donors has helped mitigate the organ shortage crisis, increasing the donor pool and reducing waitlist times. Despite these advantages, the approach raises concerns about viral transmission, long-term outcomes, and the cost-effectiveness of post-transplant DAA therapy. Furthermore, this review highlights the ethical implications of informed consent and the monitoring of HCV-negative recipients following transplantation. The outcomes from recent studies suggest that with proper management, transplantations from HCV-positive donors to HCV-negative recipients can be safe and effective, leading to excellent graft function and patient survival. This review synthesizes existing research and offers insights into optimizing protocols for future transplants involving HCV-positive donors.

Long-term outcomes of heart re-transplantation from HCV-viremic donors based on UNOS registry

Abstract Background The use of hepatitis C virus (HCV) viremic donors increased the heart donor pool, and reduced waitlist time and mortality among first-time single-organ heart transplant (HT) candidates without compromising their post-transplant survival. The outcomes of heart re-transplantation (re-HT) with the use of HCV-viremic donor grafts have not been investigated. Methods Using the United Network of Organ Sharing (UNOS) Registry we analyzed all adult patients who underwent single-organ heart re-HT in the United States between January 1, 2016, and December 31, 2022. HCV-viremic donors were defined by a positive nucleic acid amplification test (NAT+). Graft survival rates between HCV-viremic and HCV-non-viremic donor graft recipients were compared using a log rank test. Results During the study period, of 18,259 HTs performed, 427 (2.3%) constituted single-organ heart re-transplantations. Recipients of NAT+ grafts (n=19) compared to NAT- grafts (n=408) were more often male (84.2% vs 61.3%, p=0.04). Otherwise, there were no significant differences between the two groups in age, ethnicity, BMI, blood type, history of diabetes rates or stroke, creatinine or bilirubin levels, reason for re-HT, hemodynamics, use of mechanical circulatory support, and waitlist time. Ischemic time, frequency of female donors, HLA, ABO, CMV mismatch rates, and calculated panel reactive antibodies levels were comparable across the two groups. There were no significant differences in demographics or comorbidities rates between HCV-viremic and HCV-non-viremic donors apart from the cause of death. Among the donors of HCV-viremic grafts brain anoxia was reported more often (89.5%) than among HCV-non-viremic donors (40%), p <0.01. Rates of acute rejection treated in the first year after re-HT were comparable across the two groups. Over a mean follow-up of 3.0±2.1 and 3.3±1.8 years after re-HT from NAT- and NAT+ organ donors, respectively, graft survival rate at 1 year was 82% vs. 95% (p=0.3) and at 3 years 79% vs. 89%, respectively (p=0.6) (Figure). Conclusion Graft survival rates at 1 and 3 years post-heart re-HT in adult recipients of HCV-viremic donor grafts were comparable to those of recipients of HCV-non-viremic donor grafts. The current study provides compelling preliminary evidence that HCV-viremic donors constitute a viable donor pool for patients in need of heart re-transplantation.

Improvement in patient selection, management and outcomes in infant heart transplant from 2000 to 2020.

The study's primary outcome was to evaluate if post-transplant survival has improved over the last 2 decades. Secondary outcomes were the infant's waitlist mortality, waitlist time and identifying factors that affected the infant's survival. United Network for Organ Sharing (UNOS) database was queried for infants (age ≤ 1) who were listed for heart transplantation between 2000 and 2020. The years were divided into 3 eras (Era 1 2000-2006, Era 2 2007-2013 and Era 3 2014-2020). Non-parametric tests, Chi-Squared, Log-Rank test and Cox-Proportional hazard ratio were used for analysis (α = 0.05). 4234 infants were listed for heart transplants between 2000 and 2020. At the time of listing, Infants in era 3 were more likely to be heavier [in kg (P < 0.001)] and had better renal function (P < 0.001). Additionally, they were less likely to be on dialysis (P < 0.001), on a ventilator (P < 0.001) and on extracorporeal membrane oxygenation (P < 0.001). There has been a significant increase in left ventricular assist device use (P < 0.001), though there was no difference in waitlist (0.154) or post-transplant survival (0.51). In all 3 eras, waitlist survival (P < 0.001) and post-transplant survival (P < 0.001) have improved significantly. Congenital heart disease and extracorporeal membrane oxygenation were associated with worse waitlist survival in all 3 eras (P < 0.05). Infants are now waiting longer on the waitlist (in days) (33 Era 1 vs 46 Era 2 vs 67 Era 3, P < 0.001). Infant heart transplant outcomes have improved, but they are now waiting longer on the waitlist. Further improvement in increasing the donor pool, expert consensus on listing strategies and donor utilization is needed to improve outcomes.

05 The experience of youth on the waitlist for gender-affirming care in Manitoba

Abstract Background Waitlist times are often two years for youth to be seen for initial assessment for gender-affirming hormone therapy in Manitoba, Canada. It is well known that transgender youth awaiting hormone therapy have high rates of mental health challenges, including depression, anxiety, and suicidal ideation. Accessing care that is affirming and supportive, including primary care and counselling, can also be a challenge. Objectives The purpose of this study was to understand the experiences of youth and their caregivers on the waitlist for the Winnipeg, Manitoba-based Gender Diversity Affirmation and Action for Youth (GDAAY) clinic, the provincial transgender health clinic. Specifically, we were interested in what community based resources youth were accessing, mental health impacts, and suggestions for improvements. Design/Methods Qualitative, semi-structured interviews were conducted. Youth aged 14-17 years on the waitlist for 12-24 months for gender-affirming hormone therapy assessment and their caregivers were recruited. Separate interviews were conducted for youth and their caregivers. All interviews were virtual, recorded, and transcribed prior to thematic analysis. Results Youth (n=8) and caregivers (n=9) described barriers to supported transition. The first theme, “In a Black Hole” describes frustration and disappointment with the lack of regular ongoing communications from GDAAY. It also extends to the mental health challenges faced by youth and caregivers alike. Anxiety and self-harm were consistently described, with caregivers volunteering more information on self-harm and suicidality than youth. Youth described dysphoria and two youth found alternative providers for hormone therapy while on the waitlist. Our second theme, “Structural Transphobia”, describes the attitudinal, technological, physical, and architectural barriers faced by the participants. For example, one caregiver described a hospital admission for suicide attempt during which the hospital bracelet displayed the wrong gender, the wrong name, contributing to frequent mis-gendering. Frustration with the inability to change the name and gender marker in provincial charting systems was similarly of concern. Our final theme, “Manitoba: An Information Desert” describes the systemic barriers faced including lack of knowledgeable providers and reliable information within the province. Youth and caregivers described concerns with identifying primary care and councilors that understood challenges specific to transgender youth. Conclusion Although delays in gender-affirming therapy were noted, youth socially transitioned and accessed existing resources. However, mental health concerns persisted and participants felt frustrated and unsupported during their extensive wait times. Improved experiences may be achieved by additional communication from the clinic, hands-on assistance with accessing relevant resources, and an improved online presence. Potential competing interests Funding was obtained by a resident research small grant from the University of Manitoba. A similar abstract was submitted to CPEG but it focuses on a new intervention of a phone call from social work when a youth is added to the waitlist.

Evaluating the impact the Self‐Compassion App has on levels of compassion, psychological distress and well‐being

AbstractIntroductionThe Self‐Compassion App is the first commercially available, smartphone app based upon the ideas and practices of Compassion‐Focused Therapy. Through 28 sessions, the app supports individuals to develop compassionate minds and, in doing so, promotes well‐being and reduces psychological distress (e.g. self‐criticism and shame).AimThis study evaluated the impact the app had on participants' levels of compassion, well‐being, self‐criticism and psychological distress.MethodologyFifty‐two participants—consisting of staff and students at the University of Salford—took part in this study. Pre‐, post‐ and follow‐up measures were collected to explore changes in levels of compassion, self‐criticism, emotion regulation, well‐being and psychological distress.FindingsStatistically significant increases were observed in levels of self‐compassion, self‐reassurance, emotion regulation skills and well‐being. Significant reductions were found in self‐criticism, anxiety and stress, and post‐study, participants became more open to receiving compassion from others.ImplicationsResults from this study are promising and suggest that using the Self‐Compassion App reduces psychological distress and enhances psychological well‐being. Considering interventions that utilise technology with the aim of boosting well‐being, levels of compassion and reducing self‐criticism are potentially important given the difficulties that many students and educators experience, and the current waitlist times for psychological help and support.Further ResearchA randomised control trial and longitudinal study would be beneficial to explore the long‐term benefits of using the app. Further studies, in clinical and non‐clinical populations, will clarify how the app might benefit people and what type of engagement is necessary to derive change.

Body composition and muscle composition phenotypes in patients on waitlist and shortly after liver transplant – results from a pilot study

BackgroundSarcopenia is common in end-stage liver disease and negatively impacts patients awaiting or undergoing liver transplantation (LT). Magnetic resonance imaging (MRI) may be used to measure body composition and sarcopenia. We aimed to evaluate the feasibility of MRI-based LT body composition profiling, describe waitlist body composition, and assess the natural rate of change in body composition while on the waitlist and post-LT.MethodsThis prospective pilot study recruited adults listed for LT at an urban, tertiary care facility. Eighteen participants were scanned at time of waitlisting and 15 had follow-up MRIs (waitlist and/or post-LT). An 8-min MRI was used to measure body composition (AMRA® Researcher) including thigh fat-free muscle volume (FFMV) and fat infiltration (MFI), visceral (VAT) and abdominal subcutaneous (ASAT) adipose tissue volumes, and liver fat. A sex- and BMI invariant FFMV z-score (z-FFMV) was calculated, and muscle composition (MC) phenotypes were defined using the muscle assessment score (consisting of the FFMV z-score and sex-adjusted MFI). Rate of body composition change was calculated using mixed-effect modelling and is presented as rate per 30 days.ResultsAt time of waitlisting, 73% of the 18 participants had high MFI and 39% had the adverse MC (low FFMV z-score and high MFI) phenotype. Seven participants received an LT. Post-LT serial MRIs, at a median of 147 days apart within the first 200 days post-LT, demonstrated increased z-FFMV 0.22 SDs/(30 days) (p = 0.002), VAT 0.23 (p < 0.001), and ASAT 0.52 (p = 0.001) L/(30 days), but no change in MFI (p = 0.200) nor liver fat (p = 0.232).ConclusionMRI-based body composition profiling is feasible in LT patients and shortly after LT. This can be amended to routine clinical scans and may help in early identification of patients who may benefit from interventions to improve body composition. In addition, body composition changes significantly over time after LT.

Changing Landscape of Open Offers in Liver Transplantation in the Machine Perfusion Era: Exposure, Equity, and Economics.

Open offers (OOs) in liver transplantation (LT) result from bypassing the traditional allocation system. Little is known about the trends of OOs or the differences in donor/recipient characteristics compared to traditionally placed organs. We aim to quantify modern practices regarding OOs and understand NMP's impact, focusing on social determinants of health (SDH), cost, and graft-associated risk. LTs from 1/1/2018 to 12/31/2023 at a single center were included. NMP was implemented on 10/1/2022. The CDC (centers for disease control)-validated social vulnerability index (SVI) and donor risk index (DRI) were calculated. Comprehensive complications index (CCI), Clavien-Dindo grades, patient and graft survival, and costs of transplantation were included. 1162 LTs were performed; 193 (16.8%) from OOs. OOs were more common in the post-NMP era (26.5%vs. 13.3%, p < 0.001). Pre-NMP, patients receiving OOs had longer waitlist times (118 vs. 69 days, p < 0.001), lower MELDs (17 vs. 25 points, p < 0.001), and riskier grafts (DRI=1.8 vs. 1.6, p=0.004) compared to standard offers. Post-NMP, recipients receiving OOs demonstrated no difference in waitlist time (27vs. 20 days, p=0.21) or graft risk (DRI=2.03vs. 2.23, p=0.17). OO recipient MELD remained lower (16 vs. 22, p < 0.001). OO recipients were more socially vulnerable (SVI), pre-NMP (0.41vs. 0.36, p=0.004), but less vulnerable after NMP (0.23vs. 0.36, p=0.019). Despite increased graft risk, pre-NMP OO-LTs were less expensive in the 90-day global period ($154 939vs. $178 970, p=0.002) and the 180-days pre-/post-LT ($208 807vs. $228 091, p=0.021). Cost trends remained similar with NMP. OOs are increasingly utilized and may be appealing due to demonstrated cost reductions even with NMP. Although most OO-related metrics in our center remain similar before and after machine perfusion, programs should take caution that increasing use does not worsen organ access for socially vulnerable populations.

Impact of Medicaid expansion on kidney transplantation in the State Oklahoma.

There is no data evaluating the impact of Medicaid expansion on kidney transplants (KT) in Oklahoma. To investigate the impact of Medicaid expansion on KT patients in Oklahoma. The UNOS database was utilized to evaluate data pertaining to adult KT recipients in Oklahoma in the pre-and post-Medicaid eras. Bivariate analysis, Kaplan Meier analysis was used to estimate, and cox proportional models were utilized. There were 2758 pre- and 141 recipients in the post-Medicaid expansion era. Post-expansion patients were more often non-United States citizens (2.3% vs 5.7%), American Indian, Alaskan, or Pacific Islander (7.8% vs 9.2%), Hispanic (7.4% vs 12.8%), or Asian (2.5% vs 8.5%) (P < 0.0001). Waitlist time was shorter in the post-expansion era (410 vs 253 d) (P = 0.0011). Living donor rates, pre-emptive transplants, re-do transplants, delayed graft function rates, kidney donor profile index values, panel reactive antibodies levels, and insurance types were similar. Patients with public insurance were more frail. Despite increased early (< 6 months) rejection rates, 1-year patient and graft survival were similar. In Cox proportional hazards model, male sex, American Indian, Alaskan or Pacific Islander race, public insurance, and frailty category were independent risk factors for death at 1 year. Medicaid expansion was not associated with graft failure or patient survival (adjusted hazard ratio: 1.07; 95%CI: 0.26-4.41). Medicaid expansion in Oklahoma is associated with increased KT access for non-White/non-Black and non-United States citizen patients with shorter wait times. 1-year graft and patient survival rates were similar before and after expansion. Medicaid expansion itself was not independently associated with graft or patient survival outcomes. Ongoing research is necessary to determine the long-term effects of Medicaid expansion.

WP2.6 - Improving theatre utilisation and reducing waiting list times – could ‘standby’ patients be the answer?

Abstract Aims With the NHS waiting list at a record high of over 7.3 million patients, it has never been more important to maximise theatre productivity. We piloted a ‘standby patient’ initiative for patients awaiting elective day-case procedures, with the aim of optimising theatre utilisation, reducing waiting lists, improving hospital revenue and ultimately patient care. Methods The principle of a ‘standby’ patient is to reduce the rate of ‘on the day’ cancellation and utilise theatre time. Suitable patients were offered the opportunity to be on ‘standby’ for selected day case lists. If list capacity allowed, the patient was called in. If postponed, they were offered a dedicated date. A patient questionnaire was also conducted to gain an understanding of the ‘standby’ patient experience. Results Between May and November 2023, 12 ‘standby' patients were identified, average waiting list time of 44 weeks. Cases included hernia repairs and laparoscopic cholecystectomies. 6/12 were operated on their standby slot, 1 patient cancelled, and 5/12 were postponed but had surgery within an average of 6 weeks. This earnt the trust approximately £15240 in additional tariff. 10/12 patients responded to the patient questionnaire with all reporting either good or excellent experience of the initiative. Positive comments included ‘good communication’ and ‘excellent standard of care’. Conclusion The standby patient initiative is well received by patients, and provides a cost-effective solution to optimise theatre utilisation, reduce waiting list times, and improve patient care. Following this successful pilot, we plan to introduce the standby patient across further surgical lists within the trust.

Factors Associated with Waitlist Time on Liver Transplantation

Objectives: Liver transplantation (LT) is the main therapy for patients with cirrhosis or fulminant liver failure. However, there is a disproportion between the demand and availability of organs, such that the waitlist mortality ranged from 20 to 38% when the only allocation criterion was the time of inclusion on the waitlist. Brazil then adopted the Model for End-stage Liver Disease (MELD) score, aiming to prioritize patients with a higher risk of death for LT. !erefore, this study aimed to determine factors associated with waitlist time for LT. Methods: Retrospective cohort study of adult patients listed for LT from October 2012 to December 2019 in a single state in Brazil. Results: !e study analyzes 1,262 patients (869 males, 68.91%; median age, 53.33 ± 11.48 years; median waitlist time, 103.88 ± 162.05 days; median MELD Sodium [MELD-Na] score of 22.41 ± 6.09). Alcoholic liver cirrhosis (n = 369; 29.24%) and chronic viral hepatitis (n = 295; 23.38%) were the most prevalent reasons for LT. Blood groups O (n = 534; 42.31%) and A (n = 474; 37.56%) prevailed among the recipients. !e state capital and its metropolitan region accounted for 91.20% (n = 1,151) of all liver transplants performed. Most donors were deceased (n = 1,258; 99.68%). Patients with MELD-Na scores &gt; 21 (p &lt; 0.001), non-O blood group (p = 0.002), age &lt; 53 years (p = 0.003), and those listed ≥ 2017 spent ≤ 30 days on the waitlist (p &lt; 0.001). Conclusion: A waitlist period of ≤ 30 days was associated with higher MELD-Na scores, younger ages, non-O blood groups, and LT listings before 2017.

Effect of pulmonary rehabilitation duration on exercise capacity and health-related quality of life in people with chronic obstructive pulmonary disease (PuRe Duration Trial): A randomized controlled equivalence trial.

There is no strong evidence on the optimal duration of pulmonary rehabilitation (PR) programmes. The aim of the study was to determine whether an 8-week PR programme was equivalent to a 12-week PR programme in improving endurance exercise capacity in people with chronic obstructive pulmonary disease (COPD). Participants with COPD were randomized to either an 8-week (8-wk Group) or 12-week (12-wk Group), twice weekly, supervised PR programme consisting of endurance and strength training and individualized self-management education. Between group comparisons were made at completion of each programme (i.e., week 8 or week 12), for both programmes at week 12, and at 6-12-month follow-up. The primary outcome was endurance exercise capacity measured by the endurance shuttle walk test (ESWT) with the minimally important difference of 186 s set as the equivalence limit. Sixty-six participants [mean (SD); age 69 (7) years, FEV1 48 (17) %predicted] were randomized (33 per group). Between-group comparisons demonstrated that the ESWT time was equivalent for the 12-wk Group compared to the 8-wk Group at programme completion [mean (95% CI)] [71 s (-61 to 203)], week 12 [70 s (-68 to 208)], and 6-12-month follow-up [93 s (-52 to 239)], though superiority of the 12-wk Group could not be ruled out at each time point. Equivalence was shown between 8-and 12-week PR programmes for endurance exercise capacity, but superiority could not be ruled out for the 12-wk Group. Decisions about programme duration may depend on local waitlist times, healthcare budgets and patient preference.