Waitlist Management and Improving Transplant Center Outcomes

One of the universal issues we face when asked to help a program that has below standard outcomes, is how that program handles workflow and data management challenges. A big part of managing a transplant program is collecting and managing all the information needed to make good decisions. For instance, regardless of the type of transplant, one common factor that determines who receives the Gift of Life, and when, is the Waitlist. Management of this seemingly simple list can become a daunting task[waitinglist] when one considers the complexities of not only transplantation itself, but also of the information management required to determine appropriate candidates to place on the waitlist and ultimately carry out that transplant.

Sometimes, as we discussed previously, a patient's status on the list is influenced by the results of certain lab tests that determine a disease severity score, for example the MELD score. More commonly however, placement on the list and maintaining that patient's ready status requires an ongoing effort by the transplant center to collect and re-collect thenecessary clinical data to determine whether a patient is an appropriate candidate and whether they should remain a candidate while waiting on the list.

When these results are available within a program's health system EMR, the task becomes easier as the data is usually interfaced into the transplant database. However, with the increased mobility of patients, as well as the utilization of outreach clinics and outside laboratory and imaging centers for patient convenience, data often flows to the program from a variety of locations. As a result, programs need to hardwire processes that can handle this data. This task may fall upon a data coordinator, but more commonly, it falls upon clinical staff and invariably detracts from the time that they may spend with patients. One potential solution is to automate the input of data into the program's database so that the information is available for all to review on a timely basis. Such a solution would not only free up valuable staff time but improve the flow and accuracy of the data. As a result, patients may be listed quicker, be more likely to be ready when an offer is received, and more importantly, have better results. From the center's perspective, this leads to lower organ offer turn down rates, improved transplant rates and improved outcomes.

About the Author: Dr. John Daller, MD, PhD, FACS

As a former Director of several transplant programs, Dr. Daller has expertise in all aspects of transplant program management, as well as hospital program development including clinical, regulatory, business and administrative leadership via his company Strategic Illuminations. He consults in the area of medical legal review, due diligence and scientific evaluations, as well as utilization review via Daller Consulting. He is also Chief Medical Officer of Concordia Valsource, LLC which provides consultative services to developing biopharmaceutical companies and to Venture Capital groups investing in the health and life sciences. Previously, Dr. Daller was Vice President for Medical Programs in the Transplant Business Unit of Genzyme Corporation.