Download High Quality Renal Transplantation: Efficiency Counts

High Quality Renal Transplantation:
Efficiency Counts
David R. Holt, M.D., F.A.C.S.
Susan Hou, M.D.
David Hatch, M.D.
Claudia Peano, M.D.
Dadi Ding, R.N.
Billie Kostro, R.N.
Mary Kay Larson, R.N.
Anita Pakrasi, R.N.
Laura Michalski, Pharm. D.
Opportunity Statement
Although the renal transplant program enjoyed good
results with regard to rejection and survival rates, it
was felt the quality of the program could be
maintained while shortening the initial hospital stay
and decreasing costs.
Goal: To establish a protocol for postoperative care
and immunosuppression which would decrease the
initial length of stay and costs for transplantation
Most Likely Causes



Previous protocol for induction immunosuppression
required hospitalization for infusion
Special laboratory tests were necessary for
monitoring induction immunosuppression adding
costs
Initial kidney function monitoring and patient follow
up were performed on an inpatient basis
Implementation


New induction immunosuppression protocol was
devised making use of alternative
immunosuppressive medications
Postoperative protocol modified to make more use
of homecare nursing
–
–
Clinical follow up of patient
Laboratory blood draws
Results-Length of Stay
Average Length of Stay for DRG 302: Kidney Transplant
Pre_Implementation
Implementation
15
Length of Stay
Mean = 10.6 days
10
Mean = 6.2 days
5
0
r2
r3
r4
r1
r2
r3
r4
r1
r2
r3
r4
r1
tr 1
t
t
t
t
t
t
t
t
t
t
t
t
Q
Q
Q
Q
Q
Q
Q
Q
Q
Q
Q
Q
Q
0000
00
00
01
0101
0102020202
03CY
CY
CY
CY
CY
CY
CY
CY
CY
CY
CY
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Quarter
Results-Cost
Average Quarterly Direct Cost for DRG 302: Kidney Transplant
Pre_Implementation
Implementation
55,000
Average Direct Cost
50,000
Mean = $42,776
45,000
40,000
Mean = $35,236
35,000
30,000
25,000
20,000
Quarter
Results-Acute Rejection Rate

Rejection rate within 1 year of transplant
–

7.9%
All patients successfully treated and have
functioning graft
Results-1 Year Survival
Survival Rate
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Graft
Patient
Conclusions and Next Steps

By revising the renal transplant induction
immunosuppression protocol and making better use
of homecare nursing we have reduced both length
of stay and costs for renal transplantation while
maintaining excellent patient outcomes.