Quality Forum 2013

BC Provincial Lean Network

Lean in BC: Local Stories & Interactive Discussion with Physicians and Operational Leaders

Lean in BC: Local Stories & Interactive Discussion with Physicians and Operational Leaders – Part 1:

Improving Post-Renal Transplant Services (Session E8)

Dr. Gary Nussbaumer. St. Paul’s Renal Transplant Program

Outline

• What is the problem• What was the approach• What is the solution

Background

• Exceptional Distribution Renal

Transplants– Health Canada Regulations– Informed Consent• Patients at increased risk of infectious disease

transmission

– Inconsistent Communication• Organ Retrieval • Different Health Care providers involved• How is pre-transplant information communicated to

post transplant team?

Current State

• No Clear of systemic process to ensure appropriate follow-up occurred

• Communication/Documentation– Donor procurement-in-patient chart-post

transplant clinic-regional transplant centre

• Form was not 3-hole punched

Approach

LEAN process used to document current state, identify problems, propose and implement solutions

Solution

• Standard Operating Procedure was developed and a process implemented

• Stakeholders involved– Transplant Clinical Nurse Leaders, BC Transplant

Organ Donation and Hospital Development (ODHD) Coordinator, BC Transplant Quality Assurance specialist, in-patient clinical leaders, post-transplant care team, Infectious Disease leaders (BCCDC) and SPH renal medical director

Solution

• Created a process that supports transfer of all pertinent information – Pre, peri-, and post transplant areas (including

regional clinics

Exceptional Kidney Distribution Process

Solution

• Safety Checks Established– BC Transplant faxes ED form to Post-Transplant as

a cross-check to ensure no cases are missed– If patient transfers to another clinic, the ED status

is now included on the transfer form– Yearly audit done for all patients to ensure

screening blood work has been completed

Results/Expected Results

• Expected results are that 100% of patients will have appropriate follow up in the post transplant period at 4, & 8 weeks, 6 months and 1 year

• Audit completed in April 2012 from ED data between December 2007-April 2012 demonstrated 100% of the patients (63) had appropriate follow up

Sustaining the Gains

• Ongoing tracking at each patient encounter to ensure follow up is completed

• Applying the patient transfer from to flag other patient safety issues for follow up at points of transition of transplant patient

Acknowledgements

• Clare Bannon• Jennifer Chow• Amable Cruz• Camille Rozon• Tom Tautorus• Michele Trask• The entire SPH Kidney Transplant Team