welcome to: transplant qia - ipro · abby kim-shin brandi schiffman celena o’connell. referral...
TRANSCRIPT
Welcome to:
Transplant QIA
Transplant Outreach Coordinators Webinar
The webinar will begin at 1:00 pm!
This Webinar is being recorded.
You will receive a communication email to notify you when the slides and
recordings are available at our website.
Transplant QIA Webinar: Transplant Center Outreach Coordinator
Wednesday, August 22nd, 2018
Welcome/Opening Remarks Alexandra Cruz, Quality Improvement Coordinator
IPRO ESRD Network Program
Reminders
• All phone lines will be muted
• Please don’t place the call on hold, instead disconnect your line and rejoin the call when you are able- some mics will be open
• Please submit ALL questions and comments via chat at any time
• There will be breaks for answering Q & A
• Be present and engaged in our topic presentations
• Please be prepared for sharing and actively participating in the open discussion by commenting in the WebEx chat board
• Remain open-minded and respectful in hearing other’s opinions
p. 4
Agenda
– 1:00 pm Introduction (Alexandra) 5 minutes
_________________________________________________
– 1:05-1:20 pm Emory (Brittany Jacobson/ Karen Bryant) 15 minutes
– 1:20-1:35 pm Augusta (Martha Stipsits) 15 minutes
– 1:35-2:50 pm Piedmont (Arietta Maney) 15 minutes
– 2:50-2:05 pm Q&A Session _________________________________________________
– 2:05-2:20 pm Duke (Dr. Matthew Ellis) 15 minutes
– 2:20-2:35 pm Wake Forest (Myra Williams) 15 minutes
– 2:35-2:50 pm CMC (Brenda Thrasher) 15 minutes
– 2:50- 3:00 pm Q&A Session and Closing
p. 5
Emory
Transplant
Center Brittany Jacobson Kidney Transplant
Outreach Coordinator
Karen Bryant, RN Kidney Transplant
Outreach Coordinator
Emory University Transplant Center
p. 7
Address: 1365 Clifton Road NE, Building B, 6th Floor, Atlanta, GA 30322
Website: http://www.emoryhealthcare.org/centers-programs/kidney-transplant-program/index.html
Kidney Transplant Outreach Coordinators:
Brittany Jacobson
Email: [email protected]
Phone: 404-712-4515
Karen Bryant, RN
Email: [email protected]
Phone: 478-272-1640
Main Transplant Contact Numbers:
Main Phone Line: 1-855-366-7989
Referral Fax Line: 404-727-8972
Pre Evaluation Fax Line: 404-712-7311
Waitlist Team Fax Line: 404-778-4866
Emory Transplant Outreach Locations
p. 8
Acworth Location
Address: 4791 South Main Street,
Acworth, GA 30101
Athens Location
Address: 1181 Langford Drive, Building
200, Suite 105, Watkinsville, GA 30677
Saint Joseph’s Location
Address: 5673 Peachtree Dunwoody
Road, Suite 350, Atlanta, GA 30342
Dublin Location
Address: 200 Fairview Park Drive, Dublin,
GA 31021
Savannah Location
Address: 5354 Reynolds Street, Suite
212, Savannah, GA 31405
*Patients can receive transplant evaluations and post transplant follow up care.
Contact person: [email protected]
Our Team
p. 9
Andrew
Adams
Idelberto
Badell
Christian
Larsen
Kenneth
Newell Ronald
Parsons
Thomas
Pearson Marty
Sellers
Nicole
Turgeon
Paul
Tso
Transplant Surgeons
Transplant Nephrologists
Ashtar
Chami
Sharon
Graves
Antonio
Guasch Stephen
Pastan
Sudha
Tata Payaswini
Vasanth
Transplant Infection Disease Physicians
G. Marshall
Lyon
Aneesh
Mehta
Co – Executive Directors:
Dr. Thomas Pearson
Dr. Christian Larsen
Surgical Director:
Dr. Thomas Pearson
Medical Director:
Dr. Stephen Pastan
Director of PDE Program:
Dr. Nicole Turgeon
Senior Administrator: Anjali Basu
Senior Manager of Kidney Clinical Services and Operations: Beth Begley
Referral Management Supervisor: Nikita Green
p. 10
Our Team
Referral Coordinators:
Clevados Taylor (lead)
Lorena Buford
Alicia Pennamon
Adrienne Scott
Pre Transplant Team:
RNs -
Kenya Pearson (lead)
KeEra Price
Hermanda Prioleau
LPNs -
Monica Williams
Shelon Crowdus
Tammy King
Angela Boyd
Patient Care Coordinators:
Shelia Jackson
Katherine Hines
TeShawna Derrico
Waitlist Team:
Juanita Conner (lead)
Amy Jefferson
Indica Thomas
Social Workers:
Kelly Sprinkle
Alisha Ciavarelli
Samone Williams
Moniek Richardson
Abby Kim-Shin
Brandi Schiffman
Celena O’Connell
Referral Process
• Emory accepts referrals from dialysis centers,
MD offices, and patients who want to self refer.
• Required documents with referral:
• Primary Insurance cards (front and
back copy)
• Secondary Insurance Cards (front and
back copy)
• Form 2728
• Recent History and Physical (within 6
months)
• Recent Labs (within 3 months)
• Completed Referral Form
p. 11
2018 Referral Form
• A fax confirmation is sent back to referral
source.
• Patient’s are contacted in 2 business days
once the referral is completed.
• The patient, dialysis center, and/or the
referring MD can call the main line to get
a status update on the patient.
http://www.emoryhealthcare.org/centers-programs/kidney-transplant-program/refer-a-patient.html This link has all of the information covered in the slides:
Monthly Status Report for Dialysis Centers
p. 12
New and Improved Monthly Status Report
- Automated system
- Every Month
- Last business day of the month
We ask the dialysis centers to report any
changes that they see on the report to be
sent to
Examples:
- Patient has changed centers
- Patient is deceased
- Patient has been transplanted at another center
• Patients do not have to be on dialysis to qualify for kidney transplantation. We prefer to evaluate and
educate patients early in the course of their disease, thus providing the opportunity for preemptive
transplantation.
p. 13
Referral Guidelines
Eligibility Criteria
• Stage 4 (GFR<30ml/min) or greater chronic kidney disease
• BMI: protocol requires weight loss to a BMI of 35 or less prior to renal transplantation, and a BMI of 30
or less prior to combined kidney and pancreas transplant.
• Absence of a systemic illness or medical condition
• Example: severe cardiovascular or peripheral vascular disease and dispersed malignancy.
• Compliance: Ability to be compliant with a complicated long-term medical treatment regimen. Important
factors may include a strong social/family support system and freedom from active drug or alcohol
abuse.
• An adequate financial plan to obtain the required long-term immunosuppressive medications needed
post-transplant.
Evaluation Process
Day One: The patient will be scheduled for the following:
- EKG
- Chest X-Ray
- Consultations with a mid-level provider
- Social worker
- Financial Coordinator
- Pre Transplant Coordinator
- Dietician
p. 14
Day Two:
The patient will have consultations with the
following specialists:
- Transplant surgeon
- Transplant nephrologist
If applicable:
- Cardiologist
- Mental health specialist
- Hepatologist
- Hematologist
- Pulmonologist
Additional Testing • Colonoscopy - required in all patients over age 50 who have not had a colonoscopy in the last 10 years.
• Pap smear and gynecological exam (following ACOG guidelines) are required as directed for HIV negative recipient candidates.
• Age 21 – 30: every two years,
• Age 30 and older: every three years as long as the most recent exam was negative.
• Mammogram - required in all women over the age of 35 and should be performed within one year of the transplant evaluation then maintained annually
• MRI or CT of abdomen and pelvis required in all patients with diabetes and all patients with a history of peripheral vascular disease.
• Carotid duplex required in all diabetic patients and in other patients as indicated by medical history or physical examination findings.
• Cardiac testing may consist of an echocardiogram, a dobutamine stress test or a thallium stress test.
Emory Transplant Statistics
2017FY
Total Transplants: 295
DD – 175
LD – 87
K/P – 32
Pancreas – 1
p. 15
2018FY
Total Transplants: 273 – present
DD – 167
LD – 80
K/P – 26
Pancreas - 0
Fiscal Year (FY): September 1 – August 31
Q&A
p. 16
Augusta University
Medical Center-
Transplant
Program
Martha J. Stipsits, MHA, BSN, RN Administrator, Transplant Services
Our New Center!
Opened in May of 2017
1120 15th Street, Augusta GA 30912
Professional Office Building, 3rd Floor
706-721-2888
706-721-1394 (fax)
Expanded patient-centric care delivery:
Life Link Foundation Patient Resource Library
Comfortable, highly equipped exam rooms
Waiting area with amenities
Administration Space Adjacent to clinic Multidisciplinary team together Social Work, Pharmacy, dietitian Financial & Nurse Coordinators NPs, Surgeons & Nephrologists
Medication Assistance Program (MAP)
Introduction
• Legacy Transplant Program – 1st kidney transplant in 1968
• Serving Georgia and South Carolina primarily but extend to Florida, North
Carolina, Alabama and surrounding states
• Over 2600 kidney transplants completed since our inception
• Offer kidney/pancreas/living donation/pediatric transplant
• Offer Kidney Paired Donation programs (donor and recipient incompatible with
each other but match another pair at our program or an outside transplant
center)
13
47
4
60
14
50
2
64
20
53
2
73
LIVING DONOR DECEASED DONOR PANCREAS TOTAL VOLUME
Transplant Volume
FY 16 FY 17 FY 18 Linear (FY 18)
Our Physician Team
Todd Merchen, MD, FACS
Chief, Transplant Surgery
Carlos Zayas, MD, FACS, FASN, FAST
Medical Director, Transplant Program
Muhammad Irfan Saeed, MD, FACS
Assistant Professor of Surgery
Imran Gani, MD
Transplant Nephrologist
Rajan Kapoor, MD, FASN
Transplant Nephrologist
Laura Mulloy, DO
Transplant Nephrologist
Team Center Team (48 personnel)
Providers
Surgeons 2
Txp Nephrologists 4
APPs 2.6 (adding 1.5)
Transplant Coordinators
Pre 5
Living Donor 2
Post 2
Outreach 3
LPN 1
Administrator 1
Nurse Manager (adding 1)
Database Support 1
Registry Specialist 1
Ancillary Team
Pharmacists 2
Social Work 3.5
Dietitian 1
Financial Coordinator 2
Fundraising Coordinator 1
Admin Assistants 5
Billing Specialist 1
Senior Admin Specialist (adding 1)
Clinic Support
Infusion RN 1
LPN 1
CMA (adding 1)
Desk Support 2
Paul Beck, RN, BSN, CCTC
South & West GA
Augusta and SC – within 50 miles of Augusta
706-840-5654
Jeanine Davis, RN, BSN, CCTC
East Georgia and Costal SC
706-726-0498
Dee Derrick, RN, BSN, CCTC
Rest of S. Carolina
706-691-8037
Outreach Coordinators
Key Dialysis Center Contacts
Satellite Clinics
AU Transplant Unique Qualities
• Well controlled HIV Patients
• Hepatitis B or C Patients
• Sickle Cell Disease
• Bloodless Medicine
– Closely coordinate care w/ bloodless medicine team
• Partnership with Bariatric Program
Transplant Process Referral
Patient Evaluation
Patient Selection Process
Add To Waiting List
Re-eval and assess
Transplant
Return to Nephrologist
6-8 yrs.
Average Waiting Time
General Referral Process
• Phone or Fax
• Referral Form
• 2728 if applicable
• Most recent H&P
• Recent labs with eGFR
• Medication List
After Referral:
• Patient will be contacted to complete a health
history questionnaire
• Encourage patient to complete maintenance
testing (pap smear, mammogram, colonoscopy if
age appropriate)
• Records will be screened and evaluation plan will
be determined
**If possible, send the completed patient health
history questionnaire with the referral form to speed
along the process
Referral Form:
https://www.augustahealth.org/media/file/AUMC_Txp
_Referral_02-2018.pdf
Patient Health History Questionnaire:
https://www.augustahealth.org/media/file/AUMC_New
_Patient_Packet_02-2018.pdf
Steps in the Evaluation Process
Step 1
• Orientation class
• Testing
• Have potential donors call
Step 2
• Evaluation Day with
specialized testing
• Referrals to specialist
• Exam and interview with a
transplant physician
Step 3
• Review by the Transplant
Selection Committee
Sele
ctio
n C
rite
ria
• Indication Exists
• Increase Longevity
• Increase quality of life
• Able to follow complex regimen
• Support Network
• Transportation
• Healthy weight
• No absolute exclusions
Rela
tive E
xclu
sio
ns
• Non-healing Wounds
• Age >70 (kidney); Age > 50 (pancreas)
• Tobacco use in diabetes, lupus, CAD
• Bloodless medicine patients with 2 anticoagulation agents A
bso
lute
Exclu
sio
ns
• BMI >42
• Active Substance Abuse
• Significant and irreversible CAD
• Cirrhosis
• Non-Adherence
• Inadequate social support and transportation
Waitlist Maintenance
• Blood Samples Monthly
• Regular testing (mammogram, colonoscopy, pap)
• Communication with transplant center
Types of Kidneys for Transplant
Living Kidney Donor
Given by:
A healthy volunteer who wishes to give
a kidney to a family member, friend or
stranger
How long will it last? On average 10 -30 years
How soon will I be transplanted? As soon as you and your donor
complete evaluation
Deceased Kidney Donor
Given by:
Someone who chooses to donate a
kidney after they die
How long will it last? On average 5 - 10 years
How soon will I be transplanted? Our average wait time is 6-8 years
Common
Obstacles
Incomplete Work Up
• Never finished testing
• Health Maintenance
• PRA Samples
Too Sick
• Progressive CAD
• Progressive PVD
• Cancer Wait
• Poor rehab potential
Knowledge Deficit
• Education about transplant process
• Smoking
• Contact with us
Lack of Resources
• Financial
• Transportation
• Family Support
• Dental
Communication is key!
Why Stress Living Donation?
• Improved long term outcomes
• Little or no waiting time
• Faster recovery time
• Transplants last longer on average and function more
quickly
• Many different options
• Related or Unrelated Donation
• Paired Donation
• Altruistic
• **Donor evaluated independently
Conclusion
All questions can be handled quickly
Contact the outreach coordinators
Call 706-721-2888 for assistance M-F 0730-5pm
Partner with the transplant center for success!!
Q&A
p. 38
Piedmont Hospital
Transplant
Institute
Arietta Maney, MSW, LMSW Transplant Outreach Social Worker
Picture of presenter
Piedmont Transplant Institute 1968 Peachtree Rd, NW, 77 Bldg, 5th floor, Atlanta, GA 30309
www.piedmont.org/transplant/transplant-home
Arietta Maney, MSW, LMSW phone: 404/991-8933 or email : [email protected]
If you need additional information or have questions, please call 404.495.5785 or 1.800.605.5888
Fax: 404.609.6620 or 404.609.6728
Attn: Brianna or Shekia
p. 40
Piedmont Transplant Satellite Clinic
Pre-Transplant Kidney team
Nephrologists Eric Gibney, Christina Klein, Josh Wolf, Erica Hartmann, Jose Lizcano
Surgeons Jon Hundley Miguel Tan Emmanuel Minja Harrison Pollinger
Pre-kidney transplant team Listing coordinators: Adrienne, Edom, Stephanie
Wait-list coordinators: Rochelle, Shirley, Denise
Donor coordinators: Leanne, Julie, Barbara
Dieticians: Emmy, Sara, Alexis
Pre-transplant Kidney Team
Chris Fowler: Executive Director Katie Payne: Kidney Clinical Manager
Shekia Kirksey and Brianna Salter: Kidney referrals
Social Workers Melissa Corey Rebecca Holt-Peebles
2017/2018 Kidney Stats
• 150 Kidney, K/P, and P transplants in 2017
• Living Donor - 57
• Deceased donor - 87
• 2018 Kidney Transplants – 123 year to date
Referral for Kidney Transplant
Referral App
p. 47
Referral Process
Piedmont accepts referrals via social worker, MD offices and self referrals. Referrals are accepted via fax or our referral app. Once received, patients are contacted within 24 hours and our evaluations are scheduled within 2 weeks.
Referral Process
• 2728 form if the patient has started dialysis.
• History and Physical
• Copies of license and insurance cards
• Recent labs including GFR
• Demographic/ Facesheet
• PCP referral only if (required by insurance)
p. 49
Evaluation
The Evaluation Day
• One Day Evaluation
• Day begins with an education class taught by a pre-transplant coordinator
• Nephrology evaluation
• Social worker evaluation
• Dietician (if applicable)
• Labs
• Radiology: CXR, renal US +/- CT scan
Evaluation
• Establish candidacy for transplant – Severe chronic lung, cardiac, liver, psychiatric disease
– Active substance abuse
– Non-compliance
– Tobacco use if diabetic, CAD, PVD, lung disease
– Malignancy (except non-melanoma skin CA)
– Active infection/wound
– Active immunologic disease (ex Lupus)
– Psychosocial issues: finance, transportation, support
– Debility
– Weight
Kidney Selection Criteria
Kidney/Pancreas Transplant Selection Criteria
BMI • Old: BMI > 36 = contraindication
• New: assess waist to height ratio and surgeon input based on CT
• Central adiposity linked to wound complications
• Is surgery technically feasible?
• Goal W:H ratio < 0.7
• Consider BMI 36-42 if W:H ratio ok
• If under 40 years of age consider BMI up to 45
Cancer Screening
• Colonoscopy
• 50 or earlier if first degree relative with colon CA
• PAP – all female candidates up to 65
• Mammogram
• 40 and older every 2 years
• PSA – 45+
Cardiac Screening
• ECHO: baseline for all candidates
• Stress test
• All diabetics
• 45 +
• Multiple risk factors: obesity, smoking, HLD
• 5+ years of dialysis
• Right heart cath if pulmonary HTN on ECHO
• LHC if abnl stress OR cardiomyopathy
Substance Abuse
• Marijuana use remains contraindication per Piedmont policy
• Random drug screen
• Other illicit drug use requires completion of SARP
Compliance
• Non-compliance = major cause of graft loss
• Difficult to assess during evaluation
• Process change: dialysis attendance will be checked for all listed patients
• Pre-transplant intervention can change post-transplant course.
Selection Committee
• Each patient presented at selection committee 2 weeks after clinic visit
• Candidacy and further testing required
• 90 day to send in testing
• Once testing completed; re-committee for listing
Post Evaluation
• 2 week turnaround from referral to selection committee.
• Patient, referring MD, and dialysis center receive follow up letter with instructions.
• Patient follows up with coordinator on next steps. (Clearance letters, pathology reports, and testing)
p. 61
Status Reports
Piedmont sends out a quarterly patient status report to the dialysis clinics which helps the social workers and referring MD’s understand the patient’s listing status and what the next steps are in the listing process.
All coordinator contact info is also listed on these reports.
Patient Education
Support Group and LD Class
Robotic Surgery Piedmont Transplant Institute has the first and only transplant program in Georgia, as well as in the Southeast, offering robotic donor nephrectomy. This type of surgery is minimally invasive and allows trained physicians to operate more precisely through small, keyhole incisions which provide better visualization for the physicians than traditional laparoscopic surgery. These incisions typically take less time to heal than normal surgical incisions and donors experience much less post-operative pain with less chance of infection.
Robotic transplant procedures available at Piedmont include:
Biliary bypasses
Cholecystectomies
Choledochol cyst resection and reconstruction
Distal pancreatectomied
Pancreaticduodenectomies (Whipples)
Removal of polycystic kidneys
Robotic donor nephrectomy
Robotic liver resections
p. 65
Q&A
p. 66
Duke Kidney &
Pancreas
Transplant
Program
Dr. Matthew J. Ellis Medical Director
68
Duke Kidney & Pancreas Transplant Program
https://www.dukehealth.org/treatment/transplant-program/kidney-transplant
330 Trent Drive, Room 208 Hanes House
Durham, NC 27710
T 919.613.7777 F. 919.668.3897
Matthew Ellis, MD Medical Director
[email protected] 919.672.4123
Dianne Sodt Davitt
Administrative Director [email protected]
919.681.7982
69
Duke Kidney & Pancreas Transplant Program Volumes
• Scheduling Hub
– Dora Berganzo
– Natasha Willliams
– Katina Sanford
– Latesha Humphrey
• Nurse Clinicians
– Melody Daniel
– Rob Sutter
• Program Specialists
– Traci Woody
– Rebeccah Jamieson Drake
• Social Workers
– Jennifer Harrill
– Colleen Doyle
– Kaitlyn McCann
– Karli Pontillo
– Clarie Swift
– Roberta Wallace
70
Duke Kidney & Pancreas Transplant Program
Team Members • Dieticians
– Julie Stoops
– Rebeccah Gregory
• Financial Care Counselors
– Lisa Nelson Smith
– Erica Walker
– Anthony Keith
• Psychology
– Benson Hoffman
– Krista Ingle
– Carolina Saulino
– Greg Stonerock
• Pharmacists
– Jennifer Byrns
– Jennifer Gommer
– Matt Harris
• Nephrologists
– Matt Ellis
– Scott Sanoff
– John Roberts
– Carol Traynor
• Surgeons
– Andrew Barbas
– Brad Collins
– Allan Kirk
– Kadiyala Ravindra
– Aparna Rege
– Deepak Vikraman
– Stuart Knechtle
– Debra Sudan
• Administration
– Ian Jamieson
– Dianne Sodt Davitt
– Melissa Williams
71
Duke Kidney & Pancreas Transplant Program
Inclusion Criteria
Exclusion Criteria
72
Referral Process & Flow
Helpful Resources • 2728 • Notes: DC summaries, clinic
notes, others • PPD result • SW Assessment(s) • Nutritional Assessment(s) • Studies: CT, X rays, US, labs,
stress tests, cath • Cancer Screening: PAP,
Mammo, Colonoscopy, any prostate data for males > 50
73
Kidney Transplant Coverage
74
Duke Kidney & Pancreas Transplant
The Evaluation Day
Arrival Education Labs, EKG, CXR Lunch & Consents
Provider Appointments
Work Up
Social Work
Financial Care Counselor
Nephrology Surgery
[Dietician]
Patient
75
Patient Status Report
76
Duke Kidney & Pancreas Transplant Program
Duke Highlights Sickle Cell
Heart Failure
BMI 40
HIV/HOPE
Dual Organ Transplantation
Aggressive
77
Duke Kidney & Pancreas Transplant
Highlights
Dedicated Transplant Spaces/Teams Multidisciplinary Clinics (ID, Derm, Cards) Time from Referral to Evaluation: 42d
Time from Evaluation to Decision: 90d
Team Education & Training
Lobby Days Explore Transplant Transplant Summit Outreach Visits
78
Duke Kidney & Pancreas Transplant Program
https://www.dukehealth.org/treatment/transplant-program/kidney-transplant
330 Trent Drive, Room 208 Hanes House
Durham, NC 27710
T 919.613.7777 F. 919.668.3897
Matthew Ellis, MD Medical Director
[email protected] 919.672.4123
Dianne Sodt Davitt
Administrative Director [email protected]
919.681.7982
Q&A
Wake Forest
Baptist Hospital
Medical Center
Myra Williams Myra B. Williams, RN, BSN, CMSRN
Outreach Coordinator
p. 80
Wake Forest Baptist Medical Center
- Outreach Coordinator: Myra Williams, BSN, RN, CMSRN
• 336-408-6092; email: [email protected]
• - Transplant Referral Nurse: Nicole France, BSN, RN
• 336-713-7995; email: [email protected]
• - Referral Line: 336-713-7995 or 336-713-4193
• Fax: 336-713-5596
• Email: [email protected]
• Abdominal Organ Transplant
1 Medical Center Blvd; Janeway Tower 8th floor;
Winston-Salem NC 27157
p. 81
Contacts:
Coverage Area / Satellite Clinic
• North Carolina, Upstate South Carolina,
Southern Virginia, Eastern Tennessee and
Southern West Virginia
• Satellite Clinic:
• Greensboro Medical Plaza – North Elm
–3903 N. Elm Street, Greensboro, NC
–P: 336-713-5660 Fax 336-713-5677
p. 82
2017 / 2018 Kidney Statistics (July 1, 2017 – June 30, 2018)
• 161 Kidney, K/P and Pancreas transplants
• 116 Deceased donor
• 33 Living donor – 13 living related; 20 unrelated
• 1 combined Heart – Kidney
• 10 Kidney-Pancreas
• 1 solitary Pancreas
p. 83
2017 / 2018 Kidney Statistics (July 1, 2017 – June 30, 2018)
• WFBMC is the largest Kidney and Pancreas transplant
center in the state of NC and one of the largest centers
in UNOS Region 11 (NC, SC, KY, TN & VA)
• Overall Patient, Kidney and Pancreas graft survival
rates were 98.1%, 96.2% and 100%, respectively
• Nationwide, among top 35 most active kidney
transplant centers
• Only 5 star program in our geographic area for “getting
a deceased donor kidney transplant faster”
• One of the largest Pediatric transplant centers in the
region
p. 84
85 SRTR data July 2015 & June 2017
Adult Kidney Transplant Data
Pediatric Kidney Transplant Data
SRTR data July 2015 & July 2017
Why Wake Forest Baptist?
• Waitlist time to transplant on average is 3 years, which is one of the shortest in the region. The median wait time in Region 11 is 2.9 times longer than observed at Wake Forest.
• WFBMC accepts and cares for more complicated and elderly patients, including patients refused at other centers. To date in 2018:
• We have transplanted 2 patients > 80 years of age • Performed our 3rd successful combined Heart-Kidney transplant • Transplanted a 64 y/o Kidney-Pancreas recipient, one of the
oldest in our history, and • Successfully re-transplanted a patient for the 4th time
• We have transplanted more than 3500 patients in the 48 year history of the program
• Since 1999, we have more people living with a functioning kidney transplant than any other transplant center in NC
p. 87
Time to Kidney Transplant: Wake Forest versus Nationally
p. 88
0%
5%
10%
15%
20%
25%
30%
35%
40%
30 Days 1 Year 2 Years 3years
Wake Forest
Nationally
SRTR data July 2015 and June 2017
Wait time for Kidney-Pancreas Transplant
p. 89
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
30 Days 1 year 2 years 3 years
Wake Forest
Nationally
SRTR data June 2015 and July 2017
Transplant Data as of July, 2016
p. 90
1%
3%
2%
12%
16%
39%
27%
0%
<2 years
2-11 years
12-17 years
18-34 years
35-49 years
50-64 years
65+ years
unknown
Age of Recipient at time of transplant
Living Donor Program
• The living donor program is currently expanding and
in the last year experienced a 165% increase, which
is the largest increase since 1999
• Patients with an acceptable living donor may be
transplanted within 1-2 months of initial referral
• WFBMC has on staff a Living Donor navigator to
assist patients in exploring options for identifying a
living donor
• WFBMC participates in both local and national
Kidney Paired Donor Exchange programs
p. 91
Physicians Surgeons:
Dr. Robert Stratta, Director
Dr. Alan Farney
Dr. Jeff Rogers
Dr. Giuseppe Orlando
Dr. Colleen Jay (not pictured)
Nephrologists:
Dr. Amber Reeves-Daniel, Medical
Director
Dr. Alejandra Mena-Gutierrez (not
pictured)
Pediatric Nephrologists:
Dr. Ashton Chen (not pictured)
Dr. Jen-Jar Lin (not pictured) p. 92
WFBMC Pre & Post Transplant Team
p. 93
Pre Transplant Coordinators: Tavia Gilbert BSN, RN
Towanna Phillip BSN, RN
Leigh Creasey BSN, RN
Priscilla Jackson-Holmes BSN, RN
Myra Williams BSN, RN
Nicole France BSN, RN
Post Transplant Coordinators: Alice Voss BSN, RN
Lisa Miller BSN, RN
Hannah Countryman BSN, RN
Janet Sinkler MSN, RN
Office Nurses:
Trena Brooks BSN, RN
Leslie Carter BSN, RN
Clinical Manager: Heather James BSN, RN,
CCTC
Transplant
Administrative
Director: Carrie L. Simpkins, BSN, RN
Transplant Multi-Disciplinary Team
Social Workers:
• Pre: Kim Lewis, MSW, MA
• Post: Dori Muench, MSW, LCSW,
NSW-C
Pharmacists:
• Scott Kaczmorski, PharmD, BCPS, CPP
• William Doares, PharmD, CPP
Dietitian: Debbie Hicks, Med, RD, LDN
Advance Practice Team:
• Roberta Brown, FNP
• Debra Felts, NP
• Loretta Wilson, NP
• Megan Payne, PA-C
• Beth Moraitis, PA-C
Transplant Fellow:
• David Harriman, MD, FRCSC
Living Donor Program:
• Colleen Sheehan, BSN, RN, CCTC
• Lynette Patterson Cox, BS
p. 94
p. 95
Kidney Transplant Referral Abdominal Organ Transplant Program
Medical Center Blvd. Winston-Salem, NC 27157 Phone: 336/713-4193 Fax: 336/713-5055 [email protected]
PATIENT DEMOGRAPHICS
Today’s date: Indicate Transplant Type: Kidney ☐ Kidney/Pancreas ☐ Pancreas ☐
PATIENT INFORMATION
Patient’s last name: First: Middle: DOB:
Mailing address: City: State & Zip:
Cell Phone #: Last 4 of SSN: Home phone #:
Sex: M ☐ F ☐
Dialysis (Chronic) Start Date: Race:
White: ☐ Black ☐ Hispanic ☐ Other ☐
HT:
WT:
BMI:
NOT ON DIALYSIS
GFR __________
Days of Dialysis: MWF ☐ TTS ☐ Other ☐
Type of Dialysis: Hemo ☐ Peritoneal (PD) ☐ Home hemo ☐
Cause of ESRD:
Does patient use oxygen PRN or greater? Yes ☐ No ☐
Amputation Right ☐ Left ☐ Are you ambulating with a prosthesis? Yes ☐ No ☐
Does the patient use a wheelchair, walker or cane PRN or greater? Yes ☐ No ☐
Do you know if patient has a living donor? Yes ☐ No ☐
DIALYSIS UNIT INFORMATION / REFERRING PHYSICIAN INFORMATION
Dialysis Center:
Contact Person:
Phone:
Fax:
Nephrologist’s Name:
Phone:
Fax:
Address:
City, State, Zip:
Address:
City, State, ZIP:
What Does Our Transplant Center Need from Dialysis Facilities?
p. 96
• Patient demographic sheet
• Clean copy of insurance cards, including RX card
• Medication list
• Recent medical history & physical exam and/or recent
discharge summary – Less than 1 year old information
• If patient is NOT on dialysis, recent labs including GFR and
recent nephrology notes
• Social work evaluation
• 2728 Medicare form if patient has started dialysis
• If available, cardiac testing, EKG, echo and any radiology
results
• PPD results (if available)
Process
• Referral
• Financial Clearance
• Education Class
• Evaluation / Testing
• Selection Committee
p. 97
Education Class
• Education Class will be scheduled after a phone interview is
conducted with the transplant referral nurse and the patient is
cleared to move forward
• Class is approximately 2 hours in length and taught by our pre-
transplant coordinators
• It is recommended that patients bring at least one support person
with them to the class
• The Education Class is Free and open to the public
• For patients that have extended travel times to the clinic and have
their primary support person with them, we work with them on an
individual basis to consolidate their initial physician and social
worker visit on the same day as their education class
p. 98
Evaluation Process
p. 99
• Prior to education class:
• Colonoscopy (age dependent)
• Mammogram / Pap Smear (both are age dependent)
• Dental exam should be scheduled
• Initial testing done on first physician visit:
• CT scan (non-contrast) of abdomen and pelvis
• Chest X-ray
• Secondary testing: This will be determined at physician visit based
on exam
• Echocardiogram
• Stress test
• Carotid and Iliac Dopplers / duplex
• Additional testing may be required based on above results
Evaluation Process
p. 100
• Social Work evaluation
• Pharmacist assessment
• Dietary/Nutritionist evaluation (if necessary)
• HIV+ and Hepatitis C+ patients may require
follow-up with ID physician
• Once all testing results are final, patient will be
presented to Selection Committee, which
meets at least once a week
• Committee approval for waiting list
Expectations
• Communication occurs verbally and written with both patient
and dialysis facility regarding appointments for class and
evaluation testing
• After patient selection committee review, both verbal and
written communication will be sent to the patient and cc’d to
the Dialysis Center/referring physician
• Patients, physician offices and dialysis centers are given the
pre-transplant coordinators contact information and can
contact them at anytime during the process
• If questions or concerns arise, we encourage offices and
facilities to contact the outreach coordinator for additional
support p. 101
Quick Reference Transplant Criteria
Non-Medical (psychosocial, finance) indications:
• Shows cooperation and compliance with physician follow-up, recommendations, and prescribed medical regimen (for example, does not miss / sign off early from treatments)
• Access to adequate psychosocial support (i.e., transportation, emotional support, in-home care as needed)
• Ability to pay for transplant event, follow-up care, and post-transplant medication regimen through private insurer, Medicaid, Medicare or cash payment
p. 102
Transplant Contraindications
• BMI > 45 kg/m2 (contingent on body habitus)
• Age: > 85 years (dependent on physiological age)
• Severe psychiatric illness uncontrolled with medication, unstable
• Unresolvable psychosocial problems including lack of adequate social support network or financial resources
• Severe dementia or severe cognitive impairment
• Severe deconditioning, malnutrition, or frailty. No patients with permanent walkers / wheelchairs; cane usage is OK if being used for stability. No permanent residents of SNF or LTC facility
• Persistent or recurrent substance abuse (exclusive of marijuana or tobacco)
p. 103
Transplant Contraindications:
• Disseminated or untreated cancer • Poor cardiovascular reserve • Chronic lung disease requiring continuous oxygen
therapy • Advanced cirrhosis • Projected life expectancy < 2 years • Active untreatable infection or uncontrolled chronic
infection ( i.e., osteomyelitis, TB) • Open chronic non-healing wounds • Chronic severe intractable hypotension with evidence
of significant and irreversible cardiac dysfunction
p. 104
Hope
p. 105
Q&A
p. 106
Carolinas
Medical Center
Renal
Transplant
Program
Picture of
presenter
Brenda B. Thrasher, FNP-C, CCT Program Coordinator/ ACP/
Kidney Transplant
Carolinas HealthCare System is Atrium Health
40 Hospitals, 940 Care Locations, 7,400 Licensed Beds
Carolinas HealthCare System is Atrium Health
• First kidney transplant at CMC: May 4, 1970
• Certified by Centers for Medicare and Medicaid Services (CMS) and a member of the United Network for Organ Sharing (UNOS)
• Only 1 of 6 transplant centers in the US with its own hospital-based organ procurement program
• Offers a comprehensive multi-disciplinary approach to transplant
• Approximately 100 referrals received per month
• Performed 109 kidney transplants in 2017; to date, over 3,000 kidney transplants performed at CMC
Introduction: Our Transplant Program
Contact Information
Carolinas Medical Center
Transplant Center
PO Box 32861
Charlotte, NC 28232
Phone: 800-562-5752 Intake Coordinator: Jan Fries, RN
704-355-6649 Phone: 704-355-2948
Fax: 704-355-7616
CMC Kidney Transplant Program: Supply and Demand
Kidney Transplant Team
Transplant Surgeons • Vincent Casingal, MD
Surgical Director
• Lon Eskind, MD
• Roger Denny, MD
• J. Raul Soto, MD
Mid-Level Providers • Brenda Thrasher, FNP-C
• Michael Filsinger, PA
• Alexzandria Messer, PA
• Ashley Wagner, PA
Transplant Nephrologists
• Chris Fotiadis, MD Transplant Medical Director
• Benjamin Hippen, MD • Peale Chaung, MD • George Hart, MD • Chris Kern, DO • Adit Mahale, MD
Pharmacists • Kevin Cooper, Pharm D • Bennett Noell, Pharm D • Joslyn Brown, Pharm D
Kidney Transplant Team
Nurse Coordinators
• Kelly Carlisle, RN
• Marlay Manopaseuth, RN
• Gwen Ligon
• Kellian Scott
• Diane Derkowski, RN
• Jan Fries, RN Intake Coordinator
• Lorrie Lockwood, RN
• Judy Sar, RN
• Amy Kupsco, RN
• Christy Wallace, RN
Kidney Transplant Team
Medical Social Workers • Adrienne Hines, MSW
• Leslie Mills, MSW
Clinical Dietitians • Courtney Claugus, MS, RD
• Melanie Sims, MS, RD
Financial Coordinators • Katie Reynolds
• Crystal Reinhardt
• Michelle Kerns
Program Assistants
• Cindy Thompson
• Marilyn Jackson
• Natasha Hawkins
• Tracey Massey
• Katie Goosch
• Tammy Fea
• Yvonne Ellerbee
• Elena Henault
Criteria for Referral
•Referral must come from a dialysis center or nephrologist
•Patients with or nearing end stage renal disease (ESRD)
•Patients with advanced chronic kidney disease (CKD); all patients with advanced CKD should be considered for transplant evaluation
•Decreasing glomerular filtration rate (GFR); physicians are encouraged to refer all medically appropriate patients once a GFR of less than 30 mL/minute is reached
*Every medically appropriate patient deserves an opportunity to be referred for kidney transplant evaluation in a timely manner in order to reap the significant lifestyle and survival benefits experienced from transplant (Retrieved from https://optn.transplant.hrsa.gov )
Absolute Contraindications
• Active substance abuse
• Advanced cardiovascular disease
• Patient refusal
• Advanced neuropsychiatric illness
• Untreated malignancy
Why a Patient May NOT be a Transplant Candidate…
• Medical issues, such as advanced heart or lung disease, cancer
• Poor physical conditioning
• Lack of adequate social or financial support
• Non-compliance with dialysis, medications or appointments
• Current use of illegal drugs, alcohol abuse, and tobacco use
• Morbid obesity
Transplant Assessment Process: What Patients Need to Know
• Kidney transplantation is NOT a cure
• Understand risks and benefits of transplantation
• Getting listed for a transplant requires commitment and ownership from the patient
• Biggest Obstacles to Transplant Listing • Weight goals (BMI < 35)
• Financial/Fundraising
• Lack of support systems
• Transportation
• Getting on the wait list can move fairly quickly, but receiving a kidney transplant can take several years
Referral Forms http://www.carolinashealthcare.org/doc
uments/cmc/transplantation-referral-
form.pdf
Please include: • H&P • Insurance
information • 2728 • Cardiac testing if
the patient has had any
• Vaccinations
The Transplant Process
• First attend an educational class
• Meet with a Coordinator 1:1
• Multidisciplinary evaluations
– MSW
– Nephrology
– Surgeon
– Dietary
• Cardiac evaluation
• Labs, CXR
• Routine health maintenance
(PAP, mammogram,
colonoscopy)
Expectations
• KDU’s & patients will receive a confirmation of
referral
• KDU’s & patients will receive schedule of
evaluation
• KDU’s will receive a copy of any letters sent to
patient
• KDU’s will receive a copy of the evaluation tests
• KDU’s will receive status reports regarding their
patients
Q&A
p. 122
Quick Announcements
• Survey- Evaluate this Webinar
• Link via SurveyMonkey.com
– No need to complete WebEx questions
Thank You
Space
Alexandra Cruz, RD, LDN
Quality Improvement Coordinator
Transplant QIA Lead