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

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 100 100 5 Sherwood Forest Hospitals NHS Foundation Trust 6 7 8 9 10 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 (%) 80 60 40 56 73 75 75 85 84 71 81 69 46 42 73 74 60 66 77 81 11 Heart of England NHS Foundation Trust 12 University Hospitals Birmingham NHS Foundation Trust 20 13 Derby Hospitals NHS Foundation Trust 14 15 16 University Hospitals Of Leicester NHS Trust Worcestershire Acute Hospitals NHS Trust Nottingham University Hospitals NHS Trust 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 -------- National rate Trust 17 18 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

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

DCD referral rate 100 80 91 89 83 93 82 83 84 88 80 85 73 74 Referral rate (%) 60 40 20 0 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

Trends in Midlands DCD rates 100 80 76 % 60 40 53 47 46 44 37 33 50 45 46 54 54 54 49 56 56 52 48 48 38 46 65 51 44 46 67 69 68 69 70 56 57 57 46 47 48 50 50 42 46 45 74 56 50 20 0 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

DCD Patients not referred Midlands

Causes of death of utilised DCD doors N 16 18 14 17 13 11 17 17 8 14 20 % neurological 94% 89% 79% 100% 92% 91% 88% 94% 100% 93% 95% causes of death, hypoxic brain damage or trauma

Cause of death for patients meeting DCD referral criteria 250 Number of patients meeting DCD referral criteria 200 150 100 50 0 36 (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

Unit where patient died for patients that died of neurological causes of death, hypoxic brain damage or trauma 100 80 Percentage not referred 60 40 15 (60%) 36 (55%) 45 (57%) 205 (26%) 20 0 ICU Cardiothoracic ICU Paediatric ICU Accident & Emergency Unit where the patient died

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

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%)

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

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!

Stakeholder Analysis our interpretation Stakeholders SNODs TMs CLODs (Collaborative)

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