LifeQuest is an organ procurement organization, or OPO, which is a nonprofit responsible for the evaluation and procurement of deceased donor organs for organ transplantation. The agency also seeks to educate and increase awareness of and participating in the organ donation process.
“We didn’t have as many physicians as engaged in the process as we should have,” Mullen said. “Nurses are stellar — they are the primary driver when it comes to the OPO process.”
Through the ICU Improvement Committee, a physician-focused OPO task force was formed, chaired by Sean Kiley, M.D., a UF College of Medicine associate professor of anesthesiology and division chief of Critical Care Medicine, and Charles Crescioni, B.S.N., R.N., senior quality improvement specialist with the UF Health Sebastian Ferrero Office of Clinical Quality and Patient Safety.
The first task force meeting was held at the end of February 2019, when some initiatives were defined, issues were identified and action plans devised. Mullen also shared metrics with the group about the hospital’s donation potential.
In 2018, UF Health Shands had 22 organ donors, and 55 organs were recovered. Families declined organ donation for their loved ones 22 times, and there were 18 missed referrals — patients who met the criteria for the OPO referral but were not referred. There were 35 extubation issues — or withdrawals of care — where patients were extubated prematurely without LifeQuest having had an opportunity to evaluate the patient for the possibility of donation or rule them out. The average organ donor will provide three organs for transplantation, which amounts to 105 potential lives that could have been saved.
“Once our data was presented that way, it really hit home,” Mullen said. “It has led to an unbelievable awareness for the donor program and process in this hospital.
“We focused primarily on educating residents and physicians about the donation process and the important role they play. Earlier recognition of potential donors will lead to earlier engagement by the OPO process,” Mullen explained.
“One of the more important comments from residents and physicians was that they didn’t see us enough, so we piloted an improvement model called PDSA — Plan, Do, Study, Act,” Mullen shared. “We then did daily rounds in our three busiest units: Neuro Intensive Care Unit 47, Medical Intensive Care Unit 82 and 4 West Surgical Trauma Vascular Orthopaedic Intensive Care Unit.”
Having a daily presence was when things really started to click.
“After rounding, we would ask if there were any patients who met the clinical trigger for referrals and have the nurses refer them so we weren’t missing anyone,” Mullen said.
The number of missed referrals dropped from 18 in 2018 to 10 in 2019, a 45% decrease.