One kidney transplant center's experience: linking process improvements and Medicare/Medicaid conditions of participation.

CONTEXT: An institutional priority toward transplantation, dedicated team dynamics, aggressive clinical growth, and optimal care practices are essential for delivering exceptional care to transplant patients. The importance of multidisciplinary integration of these priorities throughout the continuum of patient care is widely recognized in the transplant arena as well as by the Centers for Medicare and Medicaid Services (CMS). In fact, it is the collaboration within these aspects of care that is necessary for certification by CMS. OBJECTIVES: To establish institution-wide practices, systems, and mechanisms to optimize performance of transplant centers through the use of evidence-based protocols, clinical innovation, and data-driven quality improvements. To develop training programs and competency based orientation addressing the topics needed for transplant nurses, multidisciplinary caregivers, and clinical transplant coordinators who provide care to transplant patients. To comply with the CMS conditions of participation for transplant centers. METHODS: Formation of a renal transplant council and multidisciplinary care team. Flow chart of hospital course from admission to discharge, carefully examining patients' progression through the continuum of care, assessing for barriers to care and knowledge deficits of transplant practitioners. RESULTS: Development of multiple clinical process improvements resulting in the creation of an environment for continuous learning, optimal transplant care, and exceptional outcomes in transplantation as well as compliance with CMS conditions of participation for transplant centers.

One hundred percent three-year graft and patient survival: kidney transplantation at Saint Joseph Hospital of Orange.

We report 99 consecutive renal transplants between 7/1/04 and 6/30/07 with 100% 3-year graft survival, statistically higher than expected per the SRTR (p < 0.01). Ninety-eight patients had antibody induction of immunosuppression with either daclizumab (n = 52) or Thymoglobulin (n = 46). Steroids were minimized with nearly all patients tapered to prednisone 5 mg by discharge. Sixteen patients experienced early rejection. Twelve of the rejections were in 85 patients who received ABO compatible first transplants. Of these 12 rejections, 11 occurred in patients who had been induced with daclizumab and one with Thymoglobulin (p = 0.01). Immunosuppression, infection prophylaxis and surveillance, and all medical and social issues potentially impacting graft or patient survival were managed by the transplant center for the first year minimum, and as long as clinically indicated post-transplant. Patients were educated to have all subsequent medical and social issues triaged by the transplant center for the life of the transplant.