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Thomas Jefferson University Hospital Case Study

Collaborative improvement: improving patient readiness

When the Thomas Jefferson University Hospital team prepared to take part in the OPTN Collaborative Innovation and Improvement Network (COIIN) project, almost 50 percent of its kidney waitlist was categorized as Inactive (patients not ready to be transplanted immediately). Inactive candidates have both an increased waiting time and a lower rate of organ transplantation, so these patients experience increased risk. During and after their participation in collaborative improvement, Thomas Jefferson University Hospital decreased its inactive waitlist by 17 percent.

The PDSA/Plan-Do-Study-Act collaborative improvement methodology helped bring structure to a number of initiatives and projects that were already under consideration but not yet acted upon, says Kristi Caldararo, Associate Administrator of Clinical Services at Thomas Jefferson. “It allowed us to try something and quickly course-correct if it was not working out. Changes happened quickly and we saw results fast.”

The collaborative experience was an opportunity to test new processes and practices. The Thomas Jefferson University Hospital team created a multidisciplinary subcommittee that included physicians, surgeons, coordinators, administrators, social workers and dieticians. This group reviewed their inactive kidney waitlist, focusing on the most common reason for inactivity—patient weight and BMI.

Using the PDSA model to test changes, a systematic approach was created to address inactivity for patients with a BMI > 35. Revisions were made to the BMI policy, weight management programs were developed, and candidates with BMI > 38 underwent additional evaluation and assessment. Thomas Jefferson waitlist nurse coordinators clearly defined agreed-upon goals and milestones with a patient, then followed up and enforced those goals. By giving them targets for reactivation, Inactive patients felt empowered to work toward the goal of being moved to Active status.

As a result of this emphasis on change, Thomas Jefferson reactivated 34 patients on their waitlist during the collaborative. The improvements continued beyond the close of the project and the inactive percentage of their waitlist dropped from 47 percent to just under 30 percent in 1.5 years.