New York has one of the lowest rates for organ donation in the country, a problem the state has been actively working on for the last few years.
In October, New York Governor Andrew Cuomo signed a number of executive orders to work toward improving donation numbers. This included making “Lauren’s Law” permanent, which requires all drivers to verify whether they’ll become an organ donor before their license is processed.
But not only does New York need more willing organ donors, it needs an efficient system to process them in a timely fashion. Organizations like LiveOnNY are seeking to do just that — and a partnership with Northwell Health is taking on the problem using telehealth.
Founded in 1978, the nonprofit works with 10 transplant centers and more than 90 hospitals in the New York metropolitan area, including Northwell, a network of 61,000 providers at 22 hospitals, and rehabilitation, outpatient and skilled nursing facilities in the area.
LiveOnNY ed Northwell about two years ago to improve the process of identifying organ donors, said Iris Berman, vice president of telehealth services at Northwell.
The pair discussed the health system’s organ donation efforts, including Northwell’s use of the Glasgow Coma Scale to determine a patient’s neurological state and organ integrity. Through these conversations, the organizations realized they were a fit.
The partnership had one goal in mind: Keep bedside nurses at their post with patients and their families and train eICU critical care nurses to take over the task of calling LiveOnNY for organ donation referrals.
Northwell partnered with Philips six years ago on their telehealth program, including an eICU program that provides video, predictive analytics, data visualization and advanced reporting to the user. And the organ donation status is right in Philip’s eICU workflow, which meant the Northwell team was already familiar with the donation process. Berman said it made the transition into the LiveOnNY program pretty seamless.
By the time LiveOnNY ed Northwell, the health system was already a year and a half into its eICU services program to provide patient care. Berman explained that as a result, training was business as usual, as a use of the Glasgow Coma Scale is part of the model.
“Learning the process of going through the ER and projecting ways to use the tool made us very accurate in our training to look at the data and identify the patient properly,” Berman said.
The training model started with critical care nurses who have a general working knowledge of the LiveOnNY process, said Matt Groveman, LiveOnNY senior development specialist. “It was more of a refresher on what kinds of patients to call us for and to provide an education,” he said.
The organizations agreed upon the clinical triggers, which the teams would use to make the determination whether a patient met the criteria for organ donation, said Groveman. While the team uses the Glasgow Coma Scale, nurses are routinely checking patients for those determinants.
“Nurses are trained in identifying potential donors, which is a very specific process for the critical care unit,” Berman said.
Training also included testing nurses to determine where there may be knowledge gaps, along with re-education to fill those holes, Groveman said. The first phase of the program was a blind stage, which let nurses monitor patients, and when they found patients meeting the critical criteria, they would call LiveOnNY and track the patient.
The idea was to give bedside nurses back the 20 to 25 minutes it would take to call LiveOnNY, which is very time-consuming for a critical care unit nurse. So instead, Berman said that task was handed to eICU nurses, who were able to take a step back for a more efficient process.
“Communication had to be a workflow,” Berman said. Not only did the nurse need to know how to identify the patient, they also needed to know who to call.
“So we developed a workflow over time, where everyone was aware of their job,” she continued. “It’s a delicate situation, so there can be no mistakes. We don’t want miscommunication with the family, but also don’t want to miss a [donation] opportunity.”
To Groveman, one of the biggest challenges was the learning curve needed when the eICU calls LiveOnNY. Initially, there was a lot of back and forth, as the nurse would need to call back for more information.
In time, however, the nurses were able to reduce the number of extra phone calls and get the information they needed, and LiveOnNY could send a coordinator to the bedside.
Initially, some of the bedside nurses were hesitant about giving up the documentation process, Berman said. But it was soon embraced, as they saw the value.
“It’s a shattering moment for the family, dealing with so many different emotions,” Berman said. “You can get wrapped up at the bedside. It’s heart-wrenching. [The nurse] is welcoming the ability to care for patients and family, and not having to be on the phone with the donation, while there’s a grieving family in need.”
So far, by partnering with LiveOnNY and leveraging Philips’ eICU, Northwell has increased total organ referrals by about 121 percent. Timeliness has also increased by 9.5 percent and donations have increased by 33.9 percent.
And organ transplants are up by 36.2 percent.