Transcript Presentation title

Commissioning the National
Organ Retrieval Service
Karen Quinn, Assistant Director, UK
Commissioning
Background to National Organ
Retrieval Service (NORS)
A UK-wide network of dedicated Organ Retrieval
Teams should be established to ensure timely, high
quality organ removal from all donors
• Fully staffed on-call availability 24/7
• Ability to despatch a team within an hour if required
• Three hour travel to donor hospital for minimum 90%
• Responsible for all equipment, perfusion fluids, drugs
and documentation for retrieval
NORS Introduced
The
UK National
Organ Retrieval Service
1 April
2010
7 Abdominal Teams
6 Cardiothoracic Teams
Abdominal teams:
Cardiothoracic teams:
Birmingham/Cardiff
Cambridge
Kings, London
Birmingham
Abdominal retrieval team
Cardiothoracic organ retrieval team
Harefield
Manchester
Multi -organ retrieval team
Leeds & Manchester
Newcastle
Newcastle
Papworth
Oxford/Royal Free, London
Multi-organ
team
rgan team:
Scotland
General principle:
• The closest available team to the donor hospital is designated to retrieve
• The other teams will provide back-up if the closest team is already committed to retrieval elsewhere
NORS KPIs
1 hour muster time (target 100%)
99.2
99
Performance is monitored
via monthly KPIs and
through clinical
governance incident
reporting
98.8
1 hour muster
time
98.6
98.4
98.2
98
2011/2012 2012/2013 2013/2014
All breaches are
investigated by the NORS
team and the outcome is
reviewed by the
commissioning team
Contract breaches are
subject to financial
penalties (£10,000)
Performance under 100%
is due to SNOD asking
teams to muster later than
one hour
NORS KPIs
3 hour travel time (target 90%)
94.2
94
93.8
93.6
93.4
93.2
93
92.8
92.6
92.4
3 hour travel time
2011/2012 2012/2013 2013/2014
Travel time should be
within three hours on
at least 90% of
occasions
Slight reduction in
performance since
2011 (from 94% to
93%), likely due to
increasing demand
and teams travelling
out of zone
NORS KPIs
% where 3 hour target met
100
80
60
% where 3 hour
target met
40
20
0
2012-07 2013-04 2013-10
to
to
to
2013-03 2013-09 2014-03
3 hour target
introduced July 2012
Reasons for early
stand-down are
monitored
Most common reason
is at the request of the
recipient surgeon
(commonly due to
concerns about organ
quality or because
donor is too stable)
NORS teams are
willing to wait for three
hours and only stand
down if the SNOD
allows it
2013/14 data
• The National Retrieval Group (NRG)
monitor NORS activity levels
Abdominal team activity
• 11 occasions when all 7
teams on call were out
retrieving
• Activity levels vary
across the teams
Cardiothoracic team activity
• Less busy than the
abdominal teams
• 0 occasions when all 6
teams were out
retrieving, 1 occasion
when 5 teams out
• Variation in team activity
levels
Example of inefficient team
travels
Retrieval team
contacted
Donor location
First notified date
Team to atten
Cambridge
1 Nottingham QMC
13MAY2012:02:41:00
Yes
Cambridge
2 Enfield Chase Farm
13MAY2012:03:40:00
No (in Nottingh
• No central coordination
Oxford
2 Enfield Chase Farm
13MAY2012:04:10:00
Yes
Birmingham
3 Bristol Frenchay
13MAY2012:06:10:00
Yes
Birmingham
4 Birmingham
Children's
13MAY2012:16:45:00
Yes
• SNODs are responsible
for organising the organ
retrieval
8
Out of zone
1
4
10
6
3
11
2
9
5 Romford
13MAY2012:16:45:00
No (in Addenb
Cambridge
6 Addenbrooke’s
13MAY2012:17:12:00
Yes
King's
5 Romford
13MAY2012:18:20:00
Yes
King's
7 Kings
13MAY2012:22:00:00
No (in Romford
Oxford
7 Kings
13MAY2012:23:25:00
Yes
Leeds/Manchester
8 Liverpool Aintree
14MAY2012:17:05:00
Yes
Cardiff
9 Bristol Frenchay
14MAY2012:20:30:00
Yes
• No knowledge of activity
across the rest of the
country
13
Within zone
Cambridge
5
7
12
14
Cardiff
10 Crewe
14MAY2012:21:20:00
No (in Bristol)
Cambridge
11 Chelmsford
14MAY2012:22:00:00
Yes
Leeds/Manchester
10 Crewe
14MAY2012:22:00:00
No (in Liverpoo
Royal Free
10 Crewe
14MAY2012:22:45:00
Yes
Royal Free
12 Harrow
14MAY2012:23:05:00
No (in Crewe)
King's
12 Harrow
14MAY2012:23:12:00
Yes
Royal Free
13 Oxford
15MAY2012:00:38:00
No (in Crewe)
King's
13 Oxford
15MAY2012:00:50:00
No (in Harrow)
Cardiff
13 Oxford
15MAY2012:00:55:00
No (in Bristol)
Cambridge
13 Oxford
15MAY2012:01:00:00
No (in Chelms
Leeds/Manchester
13 Oxford
15MAY2012:01:12:00
No (in Liverpoo
Newcastle
13 Oxford
15MAY2012:01:30:00
Yes
Royal Free
14 Basingstoke
15MAY2012:05:40:00
No (in Crewe)
King's
14 Basingstoke
15MAY2012:05:45:00
Yes
What has worked well
• Improved collaboration between NORS Teams
• Achievement of one hour muster and three hour travel
times
• Introduction of three hour stand down times for
abdominal teams
• Nationally agreed perfusion protocol for abdominal
teams
• Introduction of a tariff for consumables
What could be better
• Funding inequitable due to differing service models
• Some teams more fully utilised than others
• Ability to cope with future projected growth to meet
TOT 2020
• Sustainability
NORS Review
• NORS Review agreed by NHSBT Board Sept 2013
• Independent Chair and Project Manager appointed
March 2014
• Final Report presented to NORS Review Board March
3rd 2015
• Final report to come to NHSBT Board March 26th 2015
• Implementation Event May 21st 2015
Work streams
• Workforce
• Capacity
• Commissioning
• Future Service Requirements
Outcomes
• Standardised model for all NORS teams
• Realignment of current capacity
• KPIs focused on quality
• Flexibility to adapt to new ways of working
• Supported by co-ordinated despatch