Transcript ODT Workforce Design Project Staff Feedback Workshop Ella

ODT Workforce Design Project
South Central Regional Collaborative
13th November 2014
Ella Poppitt
Head of Service Design
Organ Donation and Transplantation
NHSBT
Outline
– Orientation to the ODT Workforce Project
– Phase 1- basis and objective
– Overview of Findings
– Future Modelling of the SN-OD role
– Overview of future plans and timescales
– Q&A
Taking Organ Transplantation to
2020 Strategy
– Measure 1 Consent/authorisation for organ donation
Aim for consent/authorisation rate above 80%
(2012/13: 57%)
– Measure 2 Deceased organ donation
Aim for 26 deceased donors per million population
(pmp) (2012/13: 19.1 pmp)
– Measure 3 Organ utilisation
Aim to transplant 5% more of the organs offered from
consented, actual donors
– Measure 4 Patients transplanted
Aim for a deceased donor transplant rate of 74 pmp
(2012/13: 49 pmp)
ODT Workforce Project Objectives
(Phase 1)
–Design a workforce model to meet the
strategic aims and targets of the TOT 2020
strategy using evidence obtained from data
and statistical review, literature review and
internal & external stakeholder engagement.
–Ensure staff feel involved in the
process and have had their views
heard.
Phase One - Complete
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Options not to work 24hrs
Remove theatre element from the role
More time required for hospital development
Time to build relationships with families
No consensus on how the role should look
International
Review
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Flexible options to meet fluctuating demand
Most roles involve 24hr working
Family facing role = greater impact on consent
Specialist and focused roles
Variety of professional backgrounds
Stakeholder
views
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Praise for SN-OD role from hospital partners
40% felt change required
Main purpose of role – donor co-ordination; family liaison, raising awareness
NHSBT staff
Workshops
Data
Analysis
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The current Specialist Nurse role and the donation pathway
Current and future donor activity
National and regional service provision
Future predicted donor activity for 2020
Length of process and time of day activity happens
National, regional and individual consent rates
Audit workload
Statistics & Data Review
for the Workforce Project
Areas of Data Investigated
– Current regional activity
– Configuration of the service
– Forward modelling to 2020
– The impact of non-proceeding activity & opportunities
– The donor process, associated timings & relationship to role
– The importance of consent
– SNOD consent rates
– Multivariate analysis on consent paper
– The impact of level 1, 2 and 3 activities and relationship to SNOD role
– The impact of audit and data collection
Regional Profile of Donation Potential
Number of potential DBD and/or eligible DCD by team,
from 1 April 2013 to 31 March 2014 (PDA data as at 9 April 2014)
900
812
800
738
Number of potential DBD and/or eligible DCD
700
622
600
514
500
473
457
439
393
400
377
369
321
300
215
200
100
0
Eastern
London
Midlands
North West
Northern
Northern
Ireland
Scotland
Organ Donation Services Team
South
Central
South East South Wales South West
Yorkshire
Trust Activity 2013/14 by Level
Trust/Board activity from 1 April 2013 to 31 March 2014 (PDA data as at 9 April 2014)
160
Level 3
(n=91)
Level 2
(n=52)
Level 1
(n=32)
140
Potential DBD and/or eligible DCD
120
100
80
60
40
20
0
Trust/Boards with at least one potential DBD and/or eligible DCD
Potential DBD and/or eligible DCD
Potential DBD (including cases where also eligible DCD)
Eligible DCD only
Level 1s Potential and Actual 2013-14
Potential donors, 2013-14
The dots on the magnified London area are not to scale
Actual donors, 2013-14
Eastern
Eastern
London
London
Midlands
Midlands
North West
North West
Northern
Northern
Northern Ireland
Northern Ireland
Scotland
Scotland
South Central
South Central
South East
South East
South Wales
South Wales
South West
South West
Yorkshire
Yorkshire
Level 1 + 2s Potential and Actual 2013-14
Potential donors, 2013-14
The dots on the magnified London area are not to scale
Actual donors, 2013-14
Eastern
Eastern
London
London
Midlands
Midlands
North West
North West
Northern
Northern
Northern Ireland
Northern Ireland
Scotland
Scotland
South Central
South Central
South East
South East
South Wales
South Wales
South West
South West
Yorkshire
Yorkshire
Level 1, 2 + 3s Potential and Actual 2013-14
Potential donors, 2013-14
The dots on the magnified London area are not to scale
Actual donors, 2013-14
Eastern
Eastern
London
London
Midlands
Midlands
North West
North West
Northern
Northern
Northern Ireland
Northern Ireland
Scotland
Scotland
South Central
South Central
South East
South East
South Wales
South Wales
South West
South West
Yorkshire
Yorkshire
DBD: Length of Process
National DBD: median timings by proceeding/non-proceeding and year
Total*
Non-proc 2013/14 (n=9)
Non-proc 2010/11 (n=10)
1.4
2.3
Proc 2013/14 (n=586)
1.5
Proc 2010/11 (n=388)
1.6
3.3
0.5
2.3
0.5
4.8
3.0
14.4
10.3
25.3
2.1
0.5
0.5
27.0
1.5
15.8
12.5
3.9
3.9
34.8
26.2
Hours
Time between first discussion with SN-OD and SN-OD attendance
Considerable regional variation 25-45 hours
Time between SN-OD attendance and family approach
Time between family approach and consent/authorisation
Time between consent/authorisation and start of operation
Time between start of operation and team left theatre
* Total time from first discussion with SN-OD to end of last offices.
This has been calculated for each patient by summing the time taken for each
individual part of the process and including half an hour for last offices.
The median has then been calculated.
(The sum of the medians for each part of the process does not equal the total median.)
DCD: Length of Process
National DCD: median timings by proceeding/non-proceeding and year
Total*
Non-proc 2013/14 (n=210)
0.9
Non-proc 2010/11 (n=128)
1.0
2.0
1.2
0.5
0.5
11.6
8.6
Proc 2013/14 (n=342)
1.2
2.0
0.5
Proc 2010/11 (n=191)
1.1
2.0
0.5
20.9
3.3
15.2
2.1
12.2
8.8
2.6
2.4
21.8
17.2
Hours
Time between first discussion with SN-OD and SN-OD attendance
Considerable regional variation 16-30 hours
Time between SN-OD attendance and family approach
Time between family approach and consent/authorisation
Time between consent/authorisation and treatment withdrawal
Time between treatment withdrawal and team left theatre
* Total time from first discussion with SN-OD to end of last offices.
This has been calculated for each patient by summing the time taken for each
individual part of the process and including half an hour for last offices.
The median has then been calculated.
(The sum of the medians for each part of the process does not equal the total median.)
Heat Maps:
Referral and SN-OD Attendance Activity
Heat Maps for all significant time points in the donation process
Consent Rate Multivariate Analysis
• Associated most strongly with family consent (p<0.0001)
• Patient ethnicity; knowledge of a patient’s wish to donate; involvement of a
specialist nurse for organ donation in the family approach
• The impact of the SN-OD on family consent
Stronger for DCD than DBD, and was significant even when the impact of
prior knowledge of the patient’s wishes was accounted for.
• Other significant factors
Cause of death; the number of family members present during the
donation conversation; the relationship of the primary consenter to the
patient.
• Family refusal is a major barrier to donation in the UK
Represents biggest opportunity to increase donor numbers, particularly for
DCD.
Improving the involvement of SN-ODs in the family approach is a key
component of current strategies to increase UK consent rates
SN-OD consent/authorisation rate
• Demonstrated numerically SN-ODs
in the current role do not actually
approach that often (2 years data)
• Variable of rates of performance by
SN-ODs
DCD
• Numbers not large (Maximum is 54
approached over 2 years- average 1
request every 2 weeks)
• Supports the need to have
numerically less specialised staff
requesting more often to become
experts
DBD
• Impact on consent if you separate
the requestor from the facilitator?
UK average is 15 approaches per
annum per SN-OD (2013/14)
PDA not designed to measure this
Can only count cases where there is no doubt over the SNOD name.
Point it time considered is who made the approach
The DCD Pathway
2013/14
SNOD
attended
NORS
attended
Actual
donors
Non proceeding
donors
(NORS attended)
DCD
3064
804
520
258
1140
DBD
1504
802
769
33
2770
2007/08
For every 1 family approached for DCD
1 patient benefited from transplantation
2012/13
For every 2 families approached for DCD
1 patient benefited from transplantation
Organs
Transplanted
Donor Activity per Regional Team
Number of proceeding and non-proceeding DBD and DCD donors
(ie any consented eligible donor with a completed Core Donor Data Form)
1 April 2013 to 31 March 2014 (UKTR data as at 23 April 2014)
300
UK Total (n=1997)
Non-proceeding DCD (n=614)
Non-proceeding DBD (n=63)
Proceeding DCD (n=539)
Proceeding DBD (n=781)
Number of proceeding and non-proceeding donors
250
79
200
15
66
150
63
80
5
64
4
8
71
100
47
60
42
32
40
Non-proceeding DCD
68
58
3
6
5
44
47
39
Non-proceeding DBD
43
4
3
5
51
43
56
60
South
West
Yorkshire
40
116
50
87
13
3
14
95
67
53
30
62
60
67
32
2
19
26
0
Eastern
London
Midlands
North
West
Northern
Northern
Ireland
Scotland
South
Central
South East
South
Wales
Organ Donation Services Team
Does not reflect the levels of SNOD attendance for DCD
Proceeding DCD
Proceeding DBD
DCD activity by ‘Cause of Death’
1 April 2013 to 31 March 2014
Respiratory failure
245 referrals, 140 attendances ,28 NORS
attendances, 25 donors= 37 kidneys, 1
liver transplanted
Multi Organ Failure
1113 referrals, 471 attendances, 3 NORS
attendances
Cancer, other than brain tumour
3 donors= 5 kidney transplants
280 referrals, 106 Attendances, 0 NORS
attendances= 0 donors
Septicaemia
Renal Failure
247 referrals, 101 attendances, 3 NORS
attendances, 3 donors, 1 kidney transplant
30 referrals, 10 Attendances, 0 NORS
attendances= 0 donors
MOF/ Cancer/ Sepsis/Renal failure as a ‘cause of death’= 688 SNOD attendances
(6 NORS attendances)= 6 Donors over 1 year
In the Context of SNOD Activity...
Cases of MOF, RF, Cancer & Sepsis
combined
• 688 SNOD attendances in 2013/14 (6
NORS attendances)
DCDs aged > 81
• 751 SNOD attendances over 4
years 2010/11-2013/14 (27
NORS attendances)
•
6 Donors, 6 Transplants
•
11 donors, 6 transplants
•
In 2013/14 NHSBT deployed a SNOD on
114 occasions for every 1 organ
transplanted
•
Over these 4 years 20102014 NHSBT deployed a
SNOD on 125 occasions for
every 1 organ transplanted
from a patient aged >81
years
• 2633 SNOD attendances over 4 years
2010/11-2013/14 (31 NORS attendances)
•
25 Donors, 30 Transplants
•
Over these 4 years 2010-2014 NHSBT
deployed a SNOD on 87 occasions for
every 1 organ transplanted
Plan: to conduct a piece of work to analyse this further: Significant impact on the
volume of work within the SN-OD role
Workforce Modelling of the
SNOD role
Clinical + demand
Structure of the model is based on the 6 main
types of activities that SNOD currently undertake
1. Consent
related
activity
 Triage of
incoming
referrals
 Attendance
to referrals
 Approach
families for
consent
2. Clinical
activity
3. Theatre
 Clinical
 Attendance
activity
to surgery in
following
theatre
consent,
excluding
theatre time
4. Hospital
development
5. Death
audits
 Activity with
 Audit of all
hospitals to
deaths in
drive referrals
ED/ICU of
and ensure
patients
compliance
below the
with
age of 81
transplantation
policies
6. SNOD –
adm activity
 Follow-up
letters to
donors
 File closure of
donors
 Prepare ODC
documentation
for hospitals’
committees
Consideration of Options
• Using the findings from phase 1 of the project
• Consideration of all options for each task- who could perform that
role?
• Whether each ‘role’ should be SNOD/ other new NHSBT role/ non
NHSBT role (i.e. a commissioned role)
• Likely impact of the National referral Centre (ODT Operational Hub)
on some tasks currently performed by a SNOD
• All role options evaluated via a workforce model including the existing
SNOD role
• Number of roles identified during workshops at a high level
Acknowledgement: Laura Hontorio Del Hoyo
Assistant Director, Blood donation and Strategy, NHSBT
Role Options Modelled- Revisited
• Dedicated requester/ consent role
• Audit role
• Hospital development
• Clinical Co-ordinator
• Theatre role
 Current SNOD role
Consideration of options +/- on
call
Commissioned/ local options
Roles in isolation of component
parts
Additional Work
– Developing high level role profiles
– Consideration to alternative models of how staff on call are
deployed to a referral
– Financial modelling of all options
Role Options Modelled- Considerations
• Dedicated requester/ consent role
• Audit role
• Hospital development
• Clinical Co-ordinator
• Theatre role
• Investigating the viability of all the options including
the current SN-OD role against many criteria
Next Steps for the Project
–Evaluate the workforce modelling and feedback to
staff the impact of the modelling on the options that
have been considered within the project- commenced
–Engage with key stakeholders in relation the potential impact of
change during this period- commenced
–Trial new role as pilots within specific regions- Evaluate
outcomes and impact- planning phase
–Take forward a paper based evaluation of potential triage
interventions alongside current practice and evaluate findingsimplement as appropriate- planning phase
–Timelines for phase 2 completion- 31st December 2015
–Implementation of any potential new workforce model for the
SN-OD role- January 2016 onwards
Role Pilot- High level outline
Split the existing SNOD into 2 roles (at the point of consent)
Separating consent/ requesting activity from the existing SN-OD role
• Potential impact on strategy
• Applies the concept of fewer individuals in a consent/ requesting only
role to maximise the frequency and the expertise of the requestor
• Supported by international evidence for increasing consent (phase 1)
• Work alongside the existing clinical role (from consent to theatres)
• Allows new role options to be modelled and piloted- develop a new
consent role and further develop the clinical role of the SN-OD
• Developing plans for a pilot in 2 regions of the UK
Workshops underway across the UK to discuss this with the SN-OD workforce
What will be the focus of
the project in phase 2?
A Consent/ Specialist requesting Role to be taken
forward via a pilot alongside the SNOD/ Clinical Role
Pilot and Implement a DCD Triage model
Thank you for your attention