KIDNEY TRANSPLANT PROCESS MANAGEMENT. IMPLEMENTATION AND INITIAL RESULTS IN A TERTIARY REFERRAL HOSPITAL

7 Feb 2025 12 a.m. 12 a.m.
WCN25-AB-4551, Poster Board= FRI-476

Introduction:

The main aim of this paper was to analyze the implementation and the initial results of a novel process management in a kidney transplant program as a continuous improvement tool in tertiary referral hospital. 

Methods:

A total quality process management in kidney trasplant program was designed during 2021 and implemented in 2023. It was based on three key points: process management, implementation of safety tools and humanization process. A trasplant kidney process management (TKPM) was designed and a total of 65 KPI (key performance indicators) were defined in several multidisciplinary sessions (anesthesiologists, surgical and hospitalización nursery, transplant coordinators, nephrologists and trasplant surgeons). An improvement tool (Deming cycle) is being used for keeping a continuous improvement in the TKPM. For increasing the process safety, a reactive (fishborne analysis) and a prospective (FEAM) tools are being used. Finally, a humanization process has been developed including focus groups (FG) with small groups of patients (for improving steps of the process since the patient perspective), instructive patients workshops and a physical training program was designed, implemented and evaluated in trasplanted kidney patients. An excel basedate was built for monitoring and follow up the KPI and recording the proposals of improvement when desviations were detected.  

Results:

A representative sample of results and follow up of KPI are shown in table 1. The main measures adopted according to the initial results of KPI were: reduction of the use of central intravenous canalization and change of schedule of inmunosuppressors (high incidence of lymphocele and wound complications). A single-use complete package of surgical material was adquired to facilitate the surgery and reduce the missing-time searching it. The conclussions obtained of FG modified several aspects: the patient flow during the admission was changed reducing the time of the patient in the emergency area, a structured phone-call was designed for trasplant candidates and a model of a shared make-decission was developed including fragility evaluation and a graft and overall predictive survival model (according to the patient caractheristics and conditions). The physical training program were followed by 30% of the patients.  

Table 1. 

KPI N %

3T 2023

Improvement measures

4T 2023

  

Arterial thrombosis

1(3,20)

No need

0(0)

  

Venous thrombosis

0(0)

No need

1(3,1%)

  

Discarded kidneys

101(57)

Extended criteria

13(25.4)

  

Urinary fistulae

0(0)

No need

0(0)

  

Urinary stenosis

0(0)

No need

0(0)

  

Wound infection

3(11)

Reduction use everolimus.

Wound dressing changed (aspirative)

2(10)

  

Cold ischemia<14h

14(37,83)

No nee

31(50,81)

  

Delayed graft function %

39

Evaluation adquistion perfusion machines

45

  

Use of central intravenous canalization %

100

Designed protocol for reducing the use

80

  

Peri-operative anesthesia visit %

34

Protocol designed

68

  

Incomplete surgical material %

30

Adquisición of single-use complete surgical package

35

  

Focus group

  

Change in the income patient flow.

Structured phone call for transplant candidates.

Shared make decisions with the patients. 

An overall and graft survival prediction model was built. 

    

Conclusions:

The implementation of a process management in a kidney trasplant program allowed us to establish a continuous improvement tool and has got the introduction of the patient in the kidney trasplant process. Several measure proposals were implemented with a improvement of the majority of KPI.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.