When a patient seems to be dying in the intensive-care unit, few things are certain. One thing that is, however, is that there’s lots to do—and not much time.
ICU nurses are charged with caring for patients until their final breaths. Yet, somewhere in between, they’re expected to call their local organ procurement organization, or OPO, to alert them of a likely death. That’s a CMS requirement: OPOs must strike agreements with hospitals, under which hospitals notify them of every imminent patient death.
“The timing is so important,” said Mike Breen Eckhard, chief nursing informatics officer at Christus Trinity Mother Frances Health System, based in Tyler, Texas. A hospital has to alert the OPO with enough time so that, if a patient’s organs are deemed eligible for donation, a procurement team has time to recover them while they’re still viable for a possible transplant.
But “at the time that a patient becomes eligible to be a donor, the nurses are really busy with the high level of acuity of that patient,” Eckhard said. It’s often a time when patients need hands-on, intensive care—taking a nurse away from the bedside, even for just a five-minute phone call, “is not in the best interest of the patient,” she said.
So, an interdisciplinary team at the health system worked on coding an alert system into its electronic health record software to automate the process. That involved creating a link between the health system’s Epic Systems Corp. EHR and the software system that its OPO—the Southwest Transplant Alliance—uses, which is from a company called Transplant Connect.
That link, developed in-house at Christus Trinity Mother Frances, didn’t cost anything to build, according to Eckhard. While it only took two weeks to create the connection, setting up appropriate legal agreements between the health system and the Southwest Transplant Alliance took longer.
Now, when a nurse enters patient information into the EHR—such as a patient on a ventilator showing signs of significant brain injury—an automated referral system sends that data directly to the Southwest Transplant Alliance, alerting the organization that a patient has qualified as a possible organ donor.
That helped Christus Mother Frances Hospital-Tyler, the first of the health system’s hospitals to go live with the system roughly a year ago, to see a 40% increase in referrals when comparing January to October 2019 to the prior-year period.
An automated system not only increases the number of viable organs available for transplant, but also saves time for nurses working in the ICU. For Eckhard, that’s one of the main benefits of the system.
Christus Trinity Mother Frances has since rolled out the automated system to all of its hospitals—in Jacksonville, Sulphur Springs, Tyler and Winnsboro, Texas.
Boosting the number of organs donated and improving how procurement organizations are measured have been recent areas of focus for the Trump administration. The federal government late last year proposed new rules to increase organ transplants, including steps to make it easier for the living to donate and to standardize how OPOs are evaluated, to ensure organs from the deceased don’t go to waste.
More than 113,000 people are wait-listed for a transplant. And nearly 20 people die every day waiting for a transplant, which makes streamlining donations from living and deceased donors a national priority.
It’s important for hospitals to strategize how to send timely referrals to OPOs, since those organ referrals are the “pipeline” for organ donations from deceased patients, noted Alex Tulchinsky, chief technology officer at the United Network for Organ Sharing. UNOS is an independent not-for-profit organization the federal government contracts with to manage the national transplant waiting list and match organ donors to recipients.
“The more donors there could be, the more donations there could be, the more transplants there could be,” Tulchinsky said. He added that an automated system, like the one developed at Christus Trinity Mother Frances, could help OPOs standardize the information they collect from hospitals when considering possible organ donations.
The Southwest Transplant Alliance is now working to link up the EHRs of two more health systems in Texas with its Transplant Connect system. Since the automated system sends a possible donor’s patient data automatically, it has saved time typically spent waiting for a nurse to find time to call the OPO’s staff and relay that information manually.
“The timing of the call is so critical,” said Patti Niles, the Southwest Transplant Alliance’s CEO. “It can make a difference between an organ getting transplanted or not.”