Children’s Hospital of Philadelphia: 2020 Pediatric Liver Collaborative participant

Project aim: streamlining communication during the pre-transplant process

Amit Shah, M.D., MSHP, pediatric transplant hepatologist, Children’s Hospital of Philadelphia

“The great thing about being invited to take part in this collaborative was the opportunity to give our liver transplant program a QI project specific to pediatric liver transplant. We know the structure and we know the stakeholders, so it was very helpful to tailor a project for us and for our patients.” — Amit Shah, M.D., MSHP, pediatric transplant hepatologist, Children’s Hospital of Philadelphia

Children’s Hospital of Philadelphia (CHOP) was an ideal candidate to participate in the OPTN’s 2020 Pediatric Liver Collaborative. The program has a strong history of pediatric liver transplant and a desire to evaluate and improve upon established processes in the pediatric liver realm.

The program has performed more than 450 liver transplants since 1989, with an annual volume of approximately 16 to 20 transplants. The hospital has always had a strong quality improvement (QI) culture, but the 2020 OPTN collaborative provided an opportunity to devote special attention to their pre-transplant communications and processes. Multiple studies have shown that effective pre-transplant communication leads to well-informed patients and families, expedited waitlist practices, and improved patient satisfaction. Amit Shah, M.D., a pediatric transplant hepatologist at CHOP and their project’s sponsor, stresses that quality improvement is interdisciplinary, and is always inclusive of patients and their families.

Dedicated structure, peer collaboration

The OPTN’s six-month pediatric liver collaborative project aimed to help pediatric liver programs improve their processes and concluded with a virtual learning congress in June of 2021. The initiative, which brought together 13 transplant programs from across the country, took place from August 2020 – January 2021 with two primary aims:

• Improve the process of liver transplantation for pediatric patients
• Increase the number of pediatric transplants performed

Led by OPTN performance improvement specialists, CHOP and the other participating programs received an improvement guide and project guidelines. They also participated in virtual coaching visits, online discussion boards, webinars and collaborative calls. Participants also had access to customized data dashboards so they could track progress throughout the project.

“That platform helped keep the momentum going – you really recognized it's not only our liver transplant program doing this, that this is a national initiative to improve pediatric liver transplant,” says Shah.

The project’s individual performance improvement coaching was another aspect that kept the team motivated, explains Jordyn Pearlman, BSN, RN, CHOP’s transplant program manager and a certified pediatric nurse. “Being able to have someone objectively look at what we were doing with our project and give us advice was extremely helpful. The regular meetings let us share the progress of our project and were a space to receive insight and advice.”

Jordyn Pearlman, BSN, RN, transplant program manager, Children's Hospital of Philadelphia

Plan-Do-Study-Act: CHOP’s PDSA approach

CHOP’s team decided to target their liver program’s pre-transplant processes, with a goal of decreasing the time from referral to listing. Getting patients on the waitlist sooner means candidates are more likely to receive a lifesaving transplant faster.

In order to accomplish their proposed improvement, Shah and Pearlman’s team developed a number of interventions around their goals to:

• Improve multi-disciplinary communication between the referring team, patients and their families, and the transplant team
• Implement interventions to decrease overall time from referral to waitlist and transplant
• Improve coordination and efficiency of the pre-transplant evaluation process

Using improvement methodology, they were able to identify areas of improvement related to pre-transplant communication, try interventions to make process changes, evaluate the effectiveness of those changes, and make informed decisions about whether to abandon any interventions that were not demonstrating the desired results.

“I really believe one of the biggest things that came out of this was just improving the culture of change – everybody wants to be involved in it,” says Pearlman. “We have a great culture already, but if you've been doing the same thing the same way for a long time, sometimes people are afraid of change. This experience has really led to the whole team being more open to change in order to improve efficiency of their own processes and the processes with patients.”

What did CHOP discover?

• Their ongoing efforts to streamline multi-disciplinary communication continue to be an important factor in providing high-value care to their patients
• Using improvement methodology allowed CHOP’s team to identify multiple areas of improvement related to pre-transplant communication
• By improving their team meetings, multi-disciplinary communication methods and pre-transplant patient communications, CHOP is seeing a trend of decreased time from referral to waitlisting

Sustaining and improving

CHOP is currently in the sustain phase of their project, and monitoring their data. They are also continuing to work on small tests of change - called PDSA (plan, do, study, act) cycles - to improve pre-transplant communication. Future plans include:

• Implementation of a standard referral intake letter and form
• Improving patient experience and team efficiency on evaluation day, including creation of an updated patient welcome packet
• Assessing other outcome metrics

Pearlman says they also benefited from closely following what other programs in the collaborative were doing. “We were able to see the culmination of the other teams’ respective projects, and it was helpful to be able to take those findings from the learning congress and see what we could apply generally to our processes to help our patients.”

Questions?

Email the OPTN Collaborative Improvement team at ci@unos.org.