Select Page
Nashville’s Ascension Saint Thomas Hospital West’s focus on quality improvement
Ascension Saint Thomas Hospital West in Nashville, Tenn

Improvement: FEATURE

Leaning into rapid growth and seizing an opportunity for improvement at Nashville’s Ascension Saint Thomas Hospital West

When a community-based transplant hospital grew their kidney program, a UNOS improvement initiative helped them strengthen and improve their processes.

Heather Marshall knows a lot about taking care of patients. A registered nurse who has worked in transplant for 25 years, Marshall is a quality coordinator for the heart and kidney transplant programs at Ascension Saint Thomas Hospital West in Nashville, Tenn. The hospital is a component of Saint Thomas Health, which is a member of Ascension Health, the largest not-for-profit health system in the U.S.

A community-based hospital, Ascension Saint Thomas Hospital West’s transplant program recently experienced a period of rapid growth. In only a few short years, their kidney program went from 50 transplants in 2017 to 152 transplants in 2020.*

“There can be growing pains when you grow that fast, but it motivates you to improve your processes and hardwire them into place so that patients get the transplants they need,” Marshall explains.

Heather Marshall and Amanda Young, smiling, standing in front of poster detailing improvement project

“It’s incredibly helpful to hear how other programs do things, because we’re not all the same, and we can all learn from how we do things differently.”

Quality coordinator Heather Marshall (left), with UNOS performance improvement specialist Amanda Young at the 2022 Transplant Quality Institute. 

Ascension Saint Thomas Hospital West recognized an opportunity to develop a proactive improvement project focused on increasing efficiencies in their kidney post-transplant processes and care. To do that, they took advantage of a UNOS-led improvement initiative that supports donation and transplant professionals and their programs by facilitating custom improvement engagements.

Championing a culture of focused quality improvement

UNOS leads the initiative, called Individual Member-Focused Improvement (IMFI), in its role as the Organ Procurement and Transplantation Network (OPTN). Through IMFI, all member organizations have access to individualized coaching on how to optimize and refine practices, and are able to leverage UNOS’ position as the central hub of the donation and transplant community.

The need: To increase efficiencies in staffing, communications and lab processes in post-transplant processes and care.

The way forward: Individualized coaching on how to optimize and refine practices from UNOS performance improvement specialists.

The UNOS performance improvement specialists who manage IMFI regularly work with members to support quality and performance improvement (QAPI). They consult with members and build their improvement project plans, which vary in scope depending on need. Some of the improvement activities offered via IMFI include, but are not limited to, UNetSM Data Portal training sessions, collaborative process mapping sessions, and peer mentoring.

IMFI, and the QAPI services it offers, aligns with recommendations from the National Academies of Sciences, Engineering and Mathematics (NASEM), who recently produced a report on the organ transplantation system that encouraged peer-to-peer sharing and transparency about successes and failures as part of progress. NASEM recommends embedding continuous quality improvement efforts like IMFI across the fabric of the U.S. organ transplantation system.

Growing into new and stronger waiting list management practices

When a transplant program undergoes growth, it’s an opportunity to closely examine internal processes and structures and make adjustments if needed. Rapidly increasing a program’s kidney waiting list from fewer than 100 to more than 250 patients, as Ascension Saint Thomas Hospital West did, can impact a range of workflows, such as staffing, communications and lab processes.

Waitlist management is vitally important when a program grows. Marshall explains that Ascension Saint Thomas Hospital West’s team wants to be able to concentrate on their patients by making sure they are completely ready for transplant in terms of current labs and other health data. Ascension also wanted to make sure they were leaning in to data and research analytic tools in ways that could help them understand their data, make better decisions, accept more organ offers and improve patient outcomes.

“We don’t go into transplant because we want to just come to work and leave,” says Marshall. “All of us want our patients to thrive so they can live their lives.”

Education and peer mentoring key to improvement

Amanda Young

“We can help you identify and implement improvements for your program.”

Amanda Young, UNOS performance improvement lead

Ascension Saint Thomas Hospital West’s high-level aim with IMFI was to increase efficiencies in their kidney post-transplant processes and care in an effort to improve their performance outcomes. To support this goal, UNOS performance improvement specialists Amanda Young and Amy Minkler designed a custom plan based on their needs.

The plan had two parts: One to help them leverage technology and data to strengthen their evidenced-based decision making from waitlist management through to post-transplant, and another to enable them to receive guidance on effective practices in post-transplant care management from their peers in the community.

“The help and the openness that Amy and Amanda and the team provided was amazing,” says Marshall.

Specific objectives and goals

Each component of Ascension’s plan had specific objectives and goals:

Education and training to empower Ascension Saint Thomas Hospital West to more thoroughly access and utilize their data for evidence-based decision making

  • The UNOS IMFI project team staff provided virtual coaching and training on UNetSM Data Services Portal resources and tools
  • Ascension Saint Thomas staff completed education modules in UNOS Connect, then underwent hands-on virtual training on a range of Data Services tools, including the Kidney Waiting List Management Tool, the Recovery and Usage Map (RUM), and the Organ Offers Report (ROO)
  • UNOS designed hands-on education sessions for all roles on the transplant team to be familiar with the features and capabilities of the tools, as well as feel empowered to regularly use the tools and reports

Peer mentoring to enable Ascension Saint Thomas Hospital West to receive guidance on opportunities for improvement and effective practices in post-transplant care management from subject matter experts

  • UNOS IMFI staff arranged consultations with a panel of transplant peers to discuss opportunities and advice for improvements across a range of areas
  • The group developed a plan for improved and more streamlined outpatient management
  • Additional session goals involved helping Ascension Saint Thomas discuss post-transplant clinical aspects such as protocols for infection prevention

Confronting pain points and consulting with peers on performance improvement

Amy Minkler

The custom plan performance improvement specialist Amy Minkler helped design included peer mentoring sessions with transplant surgeons and physicians from high-performing programs, experienced transplant quality specialist, and an OPO director.

Their peer mentoring sessions included transplant surgeons and physicians from high-performing programs, an experienced transplant quality specialist, and an OPO director, and the group was impressed with the hospital’s engagement and ability to be open and ask questions. Peer-to-peer sharing of successes and failures is how the entire donation and transplant system continues to improve.

“It’s incredibly helpful to hear how other programs do things, because we’re not all the same, and we can all learn from how we do things differently.”

Marshall describes the experience as extremely positive: “It’s really wonderful to know you’re not alone in the boat, and to know that others, who might have experienced something similar, can be honest about what might help.”

The peer mentoring validated and reinforced some changes they had already made, in addition to helping them make new ones, says Marshall. Some key changes involved strengthening protocols related to culturing perfusate, and scheduling regular meetings devoted to making sure high-risk patients are ready for transplant.

“This is a dream come true to be part of a program that’s on the move and growing — we have a great team.”

What they focused on

  • Ensuring patients are current on labs and health data
  • Understanding the data available from UNOS tools
  • Making better decisions for patients
  • Accepting well-matched organ offers, quicker
  • Improving patient outcomes

More about IMFI

IMFI isn’t just a list of QAPI ideas. The experience delivers access to a support team at UNOS that can dedicate time, resources and subject matter expertise to help you improve processes that are under your power to control. IMFI includes:

  • A project plan designed around your specific improvement goal
  • A customized engagement. Each IMFI project is unique and will be designed with your individual program or organization in mind
  • Direct and open collaboration with the IMFI project team, including peers in the donation and transplant community
  • The scope of each project will be tailored to each member organization, and the services provided will vary according to need

Email [email protected] to learn more about IMFI. OPTN members will be asked to first answer an intake questionnaire to help assess needs, and then IMFI staff will arrange a phone call to discuss a potential project plan.

*According to the most recent data collected by the OPTN.

Individualized and focused coaching to improve transplant

An expert, supportive team to help you improve processes

Illustration of a key

“It’s really wonderful to know you’re not alone in the boat, and to know that others, who might have experienced something similar, can be honest about what might help.”

Heather Marshall, quality coordinator for the heart and kidney transplant programs at Ascension Saint Thomas Hospital West

Share This