Using Service Improvement Methodology to improve DCD referral Rates Anne-Marie Hill & Ben Cole

Transcription

1 Using Service Improvement Methodology to improve DCD referral Rates Anne-Marie Hill & Ben Cole

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4 Midlands DCD referral rate 1 Walsall Healthcare NHS Trust 2 South Warwickshire NHS Foundation Trust 3 University Hospitals Of North Midlands NHS Trust 4 Burton Hospitals NHS Foundation Trust Sherwood Forest Hospitals NHS Foundation Trust University Hospitals Coventry and Warwickshire NHS Trust The Royal Wolverhampton Hospitals NHS Trust George Eliot Hospital NHS Trust The Dudley Group Of Hospitals NHS Foundation Trust Birmingham Children's Hospital NHS Foundation Trust Referral rate (%) Heart of England NHS Foundation Trust 12 University Hospitals Birmingham NHS Foundation Trust Derby Hospitals NHS Foundation Trust University Hospitals Of Leicester NHS Trust Worcestershire Acute Hospitals NHS Trust Nottingham University Hospitals NHS Trust National rate Trust Sandwell and West Birmingham Hospitals NHS Trust Shrewsbury and Telford Hospital NHS Trust 1 April 2015 to 31 March 2016, data as at 8 April 2016

5 Midlands DCD referral rate 1 April 2015 to 31 March 2016, data as at 8 April 2016

6 DCD referral rate Referral rate (%) Eastern London Midlands North West Northern Northern Ireland Scotland Team South Central South East South Wales South West Yorkshire National rate 1 April 2015 to 31 March 2016, data as at 8 April 2016

7 Trends in Midlands DCD rates % Apr 10 - Sep 10 Oct 10 - Mar 11 Apr 11 - Sep 11 Oct 11 - Mar 12 Referral rate SN-OD involved rate Apr 12 - Sep 12 Oct 12 - Mar 13 Apr 13 - Sep 13 Oct 13 - Mar 14 Apr 14 - Sep 14 Period Approach rate Consent/authorisation rate Oct 14 - Mar 15 Apr 15 - Sep 15 Oct 15 - Mar 16 1 April 2010 to 31 March 2016, data as at 8 April 2016

8 DCD Patients not referred Midlands

9 Causes of death of utilised DCD doors N % neurological 94% 89% 79% 100% 92% 91% 88% 94% 100% 93% 95% causes of death, hypoxic brain damage or trauma

10 Cause of death for patients meeting DCD referral criteria 250 Number of patients meeting DCD referral criteria (16%) 187 (84%) CVA (Intracranial haemorrhage) 45 (21%) 170 (79%) Hypoxic brain damage 16 (100%) Trauma 25 (44%) 32 (56%) 7 (39%) 11 (61%) 16 (50%) 16 (50%) Respiratory Pneumonia Cardiothoracic failure 83 (46%) 98 (54%) 28 (57%) 21 (43%) 35 (54%) 30 (46%) 26 (29%) 64 (71%) Multi-organ Septiceamia Cancer Other failure Month Referred Not referred

11 Unit where patient died for patients that died of neurological causes of death, hypoxic brain damage or trauma Percentage not referred (60%) 36 (55%) 45 (57%) 205 (26%) 20 0 ICU Cardiothoracic ICU Paediatric ICU Accident & Emergency Unit where the patient died

12 DCD Referral and consent rates of patients who died of neurological causes of death, hypoxic brain damage or trauma Neurological COD or trauma Overall Neurological COD or trauma Rate (%) Overall

13 Patients that died of neurological causes of death, hypoxic brain damage or trauma Patients that died due to neurological causes of death, hypoxic brain damage or trauma (n=454) Referred to SNOD (n=373, 82%) Not referred to SNOD (n=81, 18%) Treatment withdrawn (n=357, 96%) Treatment withdrawn (n=76,94 %) Eligible donor (n=322, 90%) Eligible donor (n=65, 86%) Family approached (n=246, 76%) Family approached (n=4, 6%) Consent/ authorisation given (n=122, 50%) Consent/ authorisation given (n=0, 0%) Actual solid organ donors (n=52, 43%) Actual solid organ donors (n=0, 0%) Transplanted (n=48, 92%) (111 transplants) Transplanted (n=0, 0%)

14 Patients that died of neurological causes of death, hypoxic brain damage or trauma Patients that died due to neurological causes of death, hypoxic brain damage or trauma (n=454) Referred to SNOD (n=373, 82%) Not referred to SNOD (n=81, 18%) Treatment withdrawn (n=357, 96%) Treatment withdrawn (n=76,94 %) Eligible donor (n=322, 90%) Eligible donor (n=65, 86%) Family approached (n=246, 76%) Family approached (n=4, 6%) Consent/ authorisation given (n=122, 50%) Consent/ authorisation given (n=0, 0%) Actual solid organ donors (n=52, 43%) Actual solid organ donors (n=0, 0%) Transplanted (n=48, 92%) (111 transplants) Transplanted (n=0, 0%)

15 Potential additional donors and transplants Patients that died due to neurological causes of death, hypoxic brain damage or trauma (n=454 ) 81 patients not referred 65 met eligibility criteria 50 families may have been approached Estimates based on proportions for patients referred to a SNOD 25 families approached may have given consent 11 patients may have become actual solid organ donors 23 additional transplants may have been performed

16 To increase DCD referral rate in the Midlands to above the National average of 82% With collaboration from our Clinical Colleagues Increase the number of Donors and Organs available for transplant To improve and save lives!

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18 Stakeholder Analysis our interpretation Stakeholders SNODs TMs CLODs (Collaborative)

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20 DRIVER DIAGRAM FOR DCD REFERRAL IDENTIFICATION REFERRAL DCD REFERRAL TRIAGE PLANNING FEEDBACK

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