Improving organ donation numbers

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William Osler Health System has made significant gains in organ and tissue donation, according to year-end data from Trillium Gift of Life Network (TGLN), the Ontario agency responsible for organ and tissue donation and transplant. TGLN reports that Osler’s conversion rate (the number of potential donors who become actual organ donors) increased dramatically at its two hospitals, Brampton Civic and Etobicoke General.

In the first three quarters of the last fiscal-year (April 2013 – December 2013), Osler’s conversation rate was 33 per cent, but during the last quarter, the rate jumped to 80 per cent at its hospitals. This means that the organs of four out of five potential donors at Osler hospitals during that quarter went on to save lives through organ donation. “As part of our commitment to ongoing quality improvement, Osler has undertaken a number of efforts to improve our organ and tissue donation performance,” says Joanne Flewwelling, Executive Vice President, Clinical Services and Chief Nursing Executive, William Osler Health System. Osler’s gains have come after months of dedicated team efforts. Last October, Osler designated its own internal physician champion for organ and tissue donation to help lead efforts – a first in Ontario hospitals.  Since her appointment, Dr. Alexandra Mcmillan, an Intensive Care Unit (ICU) physician, has focused her efforts and those of her team on educating staff and physicians about organ and tissue donation and following up on all potential organ donors at Osler’s hospitals.

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“We have done a tremendous amount of work as a team, focusing on education as well as implementing communication strategies with our staff regarding early recognition of potential donors,” says Mcmillan.

Osler’s success is encouraging, especially because Osler hospitals serve areas with below-average donor registration rates. Brampton’s and Etobicoke’s organ donor registration rate is 14 and 16 per cent respectively, while the provincial average is 25 per cent.

In addition to improving its conversion rate, Osler also improved upon its routine notification rate – how often TGLN is notified of all patient deaths or imminent deaths. Osler has seen an increase from 75 to 94 per cent in this rate in recent months. This improvement came after TGLN implemented hospital-wide notification at Osler in April 2013, which made it mandatory for every patient death to be reported. Previously, only deaths in the emergency department (ED), Critical Care Units and Palliative Care Units were required to be reported for tissue donation potential.

“Educational outreach to all staff members helped Osler achieve a baseline notification rate of 75 per cent. More notably, records show that when Osler mandated electronic notification in December 2013, we saw a 15 per cent improvement within one month,” says Dr. McMillan. “I’m happy to report that our internal monthly audit and performance feedback has resulted in a 99 per cent compliance rate at the six month mark.”

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To further boost Osler’s performance, a dedicated team comprised of a social worker, dietician, nurse educator, respiratory therapist, charge nurse and sometimes a doctor, assess ICU patients daily based on four clinical triggers established by TGLN to prompt routine notification of a potential donor. These triggers, implemented for patients who are at high risk of imminent death, include a grave prognosis, an injured brain or non-recoverable injury/illness, a family-initiated discussion of donation or a discussion of the withdrawal of life support.

To support front-line efforts, Osler also updated its corporate policy on organ and tissue donation so that it reflected the organization’s renewed efforts. “We have a multi-disciplinary approach, and our community and hospital staff have been very receptive and engaged,” says McMillan.

Osler has also made electronic record-keeping of notifications to TGLN mandatory and monthly internal audits are conducted to ensure opportunities for organ and tissue donation have not been missed. Through the audit, the files of every ventilated patient who dies in the ICU and Emergency Department are reviewed by an Osler Organ Donation Coordinator and Clinical Quality Coordinator.

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“Osler staff and physicians remain dedicated to this important work and will continue to build on these positive changes to help save more lives,” says Flewwelling.

With more than 1,500 Ontarians awaiting life-saving transplants, Osler’s goal is to achieve a 100 per cent notification rate.  Osler plans to focus its efforts on strategies that will ensure the gains made over the past months are sustainable.

Donation performance data, including routine notification and conversion rates, by hospital is available at http://www.giftoflife.on.ca/en/publicreporting.htm. One donor can save up to 8 lives and enhance up to 75 others through tissue donation. You can register consent for organ and tissue donation at www.beadonor.ca.