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Case Reviews Guide Prospective Process Improvements

The care team at Geisinger Community Medical Center (GCMC) is committed to improving the donation process, one donor and one donor family at a time.

April 27, 2018

Chad Cope, RN, Administrative Team Coordinator; Heather Bennett, RN; Lisa Litchkowski, Gift of Life Hospital Services Coordinator; Cindy Stromwell, RN; IN FRONT: Julie Le, RN

In January 2016, Megan Walbeck, MSN, RN, Inpatient Operations Manager, Geisinger Northeast, started retrospective case reviews (called “After-Action Reviews”) with the ICU care team – now nearly 35 GCMC care team members, including physicians, ED, ICU and OR nurses, respiratory therapists, chaplains and other support staff attend them on a monthly basis. Megan and Lisa Litchkowski, Hospital Services Coordinator, Gift of Life Donor Program, co-facilitate each meeting.

Chad Cope, RN, GCMC ICU Administrative Team Leader, said, “After-Action Reviews provide tremendous benefit from a leader’s standpoint. We get direct information about performance, peer and family interactions, as well as outcomes to share with our staff. This exchange is useful for improving ourselves as a unit, a hospital, and a patient advocate team in a safe, non-judgmental environment.”

During the After-Action Reviews, the GCMC care team discussed the patient’s initial presentation and the clinical efforts to save his or her life. The team knows that timely organ donor referrals are critical for giving Gift of Life Coordinators time to evaluate potential donors and work together to preserve donation opportunities.

Family-centered, compassionate care and support, and clinical donor management are other important components of G-CMC’s After-Action Reviews. Were the family’s physical, emotional, and spiritual needs met? Was the family given a thorough explanation of their loved one’s condition; did they fully understand what they were told? Did the family need extra time to comprehend the situation or spend time with their loved one? Was the family approached about donation opportunities in a planned, sensitive and collaborative manner with Gift of Life initiating the conversation? Were donor management strategies and operating room procedures optimized?

“Working with a family through the donation process is an intense human experience for the family and the medical team” — Dr. Laurie Loiacono

“Working with a family through the donation process following a life-changing tragedy is an intense human experience for the family and the medical team,” remarked Dr. Laurie Loiacono, GCMC Surgical Critical Care Specialist. “Retrospective case reviews help the team keep a positive, patient and family-centered perspective. Staff highly values this feedback, and the sessions can be very ‘therapeutic’ for the team, particularly following very difficult cases.”

When comparing the 17 months before and after retrospective organ donor case reviews were started, the organ donor conversion rate increased from 58 percent to 71 percent. From January to June, 2017, 21 recipients’ lives were saved through the generosity of donor families and the support of GCMC’s care team.