Development of key interventions and quality indicators for the management of an adult potential donor after brain death: a RAND modified Delphi approach

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Abstract

Background

A substantial degree of variability in practices exists amongst donor hospitals regarding the donor detection, determination of brain death, application of donor management techniques or achievement of donor management goals. A possible strategy to standardize the donation process and to optimize outcomes could lie in the implementation of a care pathway. The aim of the study was to identify and select a set of relevant key interventions and quality indicators in order to develop a specific care pathway for donation after brain death and to rigorously evaluate its impact.

Methods

A RAND modified three-round Delphi approach was used to build consensus within a single country about potential key interventions and quality indicators identified in existing guidelines, review articles, process flow diagrams and the results of the Organ Donation European Quality System (ODEQUS) project. Comments and additional key interventions and quality indicators, identified in the first round, were evaluated in the following rounds and a subsequent physical meeting. The study was conducted over a 4-month time period in 2016.

Results

A multidisciplinary panel of 18 Belgian experts with different relevant backgrounds completed the three Delphi rounds. Out of a total of 80 key interventions assessed throughout the Delphi process, 65 were considered to contribute to the quality of care for the management of a potential donor after brain death; 11 out of 12 quality indicators were validated for relevance and feasibility. Detection of all potential donors after brain death in the intensive care unit and documentation of cause of no donation were rated as the most important quality indicators.

Conclusions

Using a RAND modified Delphi approach, consensus was reached for a set of 65 key interventions and 11 quality indicators for the management of a potential donor after brain death. This set is considered to be applicable in quality improvement programs for the care of potential donors after brain death, while taking into account each country’s legislation and regulations regarding organ donation and transplantation.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3386-1) contains supplementary material, which is available to authorized users.

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Most cited references 19

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Reducing clinical variations with clinical pathways: do pathways work?

S Marchisio, M Panella, F Di Corte (2003)

To test clinical pathways in a variety of Italian health care organizations in 2000-2002 to measure performance in decreasing process and outcome variations. Creation of indicators, specific for each clinical pathway, to measure variations in the care processes and outcomes. Pre- and post-analysis model to evaluate the possible effect of the clinical pathways on each indicator. We tested the clinical pathways in six sites, each with different clinical pathways. Reductions in health care macro-variation phenomena (length of stay, patient pathways, etc.) and in performance micro-variation (variations in diagnostic and therapeutic prescriptions, protocol implementation, etc.) were shown in sites where pathways were implemented successfully. A significant improvement in outcome for patients who were treated according to the clinical pathway for heart failure was also demonstrated. The overall purpose of clinical pathways is to improve outcome by providing a mechanism to coordinate care and to reduce fragmentation, and ultimately cost. Our results demonstrated that it is possible to achieve this goal. Although controversial elements still exist, we think that clinical pathways can have a positive impact on quality in health care.

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Management of the Potential Organ Donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement.

Robert Kotloff, Sandralee Blosser, Gerard Fulda … (2015)

This document was developed through the collaborative efforts of the Society of Critical Care Medicine, the American College of Chest Physicians, and the Association of Organ Procurement Organizations. Under the auspices of these societies, a multidisciplinary, multi-institutional task force was convened, incorporating expertise in critical care medicine, organ donor management, and transplantation. Members of the task force were divided into 13 subcommittees, each focused on one of the following general or organ-specific areas: death determination using neurologic criteria, donation after circulatory death determination, authorization process, general contraindications to donation, hemodynamic management, endocrine dysfunction and hormone replacement therapy, pediatric donor management, cardiac donation, lung donation, liver donation, kidney donation, small bowel donation, and pancreas donation. Subcommittees were charged with generating a series of management-related questions related to their topic. For each question, subcommittees provided a summary of relevant literature and specific recommendations. The specific recommendations were approved by all members of the task force and then assembled into a complete document. Because the available literature was overwhelmingly comprised of observational studies and case series, representing low-quality evidence, a decision was made that the document would assume the form of a consensus statement rather than a formally graded guideline. The goal of this document is to provide critical care practitioners with essential information and practical recommendations related to management of the potential organ donor, based on the available literature and expert consensus.

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Lung donor selection and management.

Lieven Dupont, Philippe Nafteux, Paul Leyn … (2009)

Lung transplantation is still limited by the shortage of suitable donor organs. This results in long waiting times for listed patients with a substantial risk (10-15%) of dying before transplantation. All efforts to increase donor awareness through legislation, public campaigns, and training of transplant coordinators and medical ICU staff should be encouraged. Only a minority of cadaveric donors meets the preset ideal lung donor criteria, leaving many transplantable lungs untouched. Donor lung utilization can be further improved by careful selection of extended criteria donors, by active participation of transplant teams in donor management, and by verifying as often as possible the quality of lungs in the donor hospital by a member of the transplant team. This article aims to update the current evidence from the literature to identify and select potential lung donors and to manage cadaveric donors to maximally increase the organ yield for lung transplantation.

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Author and article information

Contributors

Pieter Hoste:

ORCID: http://orcid.org/0000-0002-3839-7766

piehoste.hoste@ugent.be

Eric Hoste: eric.hoste@ugent.be

Patrick Ferdinande: patrick.ferdinande@uzleuven.be

Koenraad Vandewoude: koenraad.vandewoude@ugent.be

Dirk Vogelaers: dirk.vogelaers@ugent.be

Ann Van Hecke: ann.vanhecke@ugent.be

Xavier Rogiers: xavier.rogiers@ugent.be

Kristof Eeckloo: kristof.eeckloo@ugent.be

Kris Vanhaecht: kris.vanhaecht@med.kuleuven.be

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 24 July 2018

Publication date PMC-release: 24 July 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 580

Affiliations

[1 ]ISNI 0000 0004 0626 3303, GRID grid.410566.0, Department of General Internal Medicine, , Ghent University Hospital, ; Corneel Heymanslaan 10, 9000 Ghent, Belgium

[2 ]ISNI 0000 0001 2069 7798, GRID grid.5342.0, Faculty of Medicine and Health Sciences, , Ghent University, ; Corneel Heymanslaan 10, 9000 Ghent, Belgium

[3 ]ISNI 0000 0001 2069 7798, GRID grid.5342.0, Department of Internal Medicine, , Ghent University, ; Corneel Heymanslaan 10, 9000 Ghent, Belgium

[4 ]Department of Intensive Care, General Hospital Sint-Lucas, Groenebriel 1, 9000 Ghent, Belgium

[5 ]ISNI 0000 0004 0626 3303, GRID grid.410566.0, Department of Intensive Care Medicine, , Ghent University Hospital, ; Corneel Heymanslaan 10, 9000 Ghent, Belgium

[6 ]ISNI 0000 0000 8597 7208, GRID grid.434261.6, Research Foundation - Flanders (FWO), ; Egmontstraat 5, 1000 Brussels, Belgium

[7 ]ISNI 0000 0004 0626 3338, GRID grid.410569.f, Surgical and Transplantation ICU, , University Hospitals Leuven, ; Herestraat 49, 3000 Leuven, Belgium

[8 ]ISNI 0000 0001 2069 7798, GRID grid.5342.0, University Centre for Nursing and Midwifery, , Ghent University, ; Corneel Heymanslaan 10, 9000 Ghent, Belgium

[9 ]ISNI 0000 0001 2069 7798, GRID grid.5342.0, Department of Public Health, , Ghent University, ; Corneel Heymanslaan 10, 9000 Ghent, Belgium

[10 ]ISNI 0000 0004 0626 3303, GRID grid.410566.0, Nursing Department, , Ghent University Hospital, ; Corneel Heymanslaan 10, 9000 Ghent, Belgium

[11 ]ISNI 0000 0004 0626 3303, GRID grid.410566.0, Department of Transplant Surgery, , Ghent University Hospital, ; Corneel Heymanslaan 10, 9000 Ghent, Belgium

[12 ]ISNI 0000 0001 0668 7884, GRID grid.5596.f, Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, , KU Leuven - University of Leuven, ; Kapucijnenvoer 35, 3000 Leuven, Belgium

[13 ]ISNI 0000 0004 0626 3338, GRID grid.410569.f, Department of Quality Management, , University Hospitals Leuven, ; Herestraat 49, 3000 Leuven, Belgium

[14 ]European Pathway Association, Kapucijnenvoer 35, 3000 Leuven, Belgium

Author information

Pieter Hoste http://orcid.org/0000-0002-3839-7766

Article

Publisher ID: 3386

DOI: 10.1186/s12913-018-3386-1

PMC ID: 6056930

PubMed ID: 30041683

SO-VID: a792448a-4a36-414c-96a4-157871cf1850

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 28 November 2017

Date revision received : 12 June 2018

Date accepted : 12 July 2018

Funding

Funded by: Belgian Federal Public Service Health, Food Chain Safety and Environment

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ScienceOpen disciplines: Health & Social care

Keywords: delphi technique,key interventions,quality indicators,critical care,deceased donation,donation after brain death

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ScienceOpen disciplines: Health & Social care

Keywords: delphi technique, key interventions, quality indicators, critical care, deceased donation, donation after brain death

Development of key interventions and quality indicators for the management of an adult potential donor after brain death: a RAND modified Delphi approach

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Background

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Results

Conclusions

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Most cited references 19

Reducing clinical variations with clinical pathways: do pathways work?

Management of the Potential Organ Donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement.

Lung donor selection and management.

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