Designated liver transplant anesthesia team reduces blood transfusion, need for mechanical ventilation, and duration of intensive care

Abstract

It was the area of manufacturing in which the idea of continuous quality improvement (CQI) originated and developed to what we consider a highly efficient model for all industries today. [1][2][3][4][5][6] Since the 1980s, when the cost of healthcare began rising faster in the United States than the cost of living, quality issues have gradually gained importance for the medical industry and the government. Furthermore, a systematic assessment of healthcare by the Institute of Medicine in 1999 revealed shocking discrepancies between outcomes. One of the main findings suggested that, despite having one of the best acute care services in the world, the United States fails to deliver consistent quality. A growing body of research has confirmed the existence of wide variations that are attributable to differences in medical practices and are unrelated to patients' preexisting medical conditions. 7 Healthcare leaders recognized long ago that education and continuous systematic development are essential to improving outcome. [8][9][10] To build on the strengths of the current system and address the weakness of inconsistent quality, healthcare organizations have initiated CQI processes with various degrees of success over the last few years. 11Our institution, the University of Wisconsin (UW), is a large transplant center with over 8000 organs transplanted to date, and it is regarded as a pioneer of organ preservation.12 This article describes the decision process, implementation, and results of a newly established dedicated liver transplant anesthesia team since 2003. PATIENTS AND METHODSAfter the commitment was made to develop a state-ofthe-art transplant anesthesiology division at UW, the CQI plan called for a series of educational, organizational, and clinical changes that were to be gradually introduced in a fashion consistent with the plan-dostudy-act cycle. The first step of the new CQI process focused on education. Creating concentrated subspecialty knowledge was accomplished by the creation of a liver transplant anesthesiology case library and the establishment of a new transplant anesthesia rotation for resident training. Evidence-based guidelines [eg, low central venous pressure (CVP) intraoperative fluid management, thromboelastography (TEG), conservative blood transfusion triggers, systematic use of antifibrinolytics for hyperfibrinolysis, and extubation in the operating room when possible] were published on the departmental intranet for all anesthesia personnel.Subsequently, we identified a group of 7 faculty volunteers who later became the dedicated liver transplant anesthesia team. None of these individuals completed a formal transplant anesthesia fellowship, but 2 were

Intraoperative Events in Liver Transplantation Using Donation After Circulatory Death Donors

“…Our center also has a dedicated liver anesthesia team for all transplant cases. There is significant literature that shows that having a dedicated LT anesthesia team influences the number of blood transfusions, number of laboratory tests performed, length of postoperative ventilation, length of ICU stay, and the rate of postoperative complications as well as mortality . Whether or not there is an association between DCD outcomes and dedicated LT anesthesia teams needs to be studied further.…”

Reducing transfusion requirements in liver transplantation

“…By addressing various aspects of the LT service, fostering strong multidisciplinary relationships and implementing evidence based protocols, Hevesi et al [125] were able to deliver improvements in patient outcomes. Transfusion rates, ventilator days and LOS fell dramatically following the introduction of their quality improvement measures ( Figure 11).…”

Director of anesthesiology for liver transplantation: Existing practices and recommendations by the united network for organ sharing

“…The inclusion of administrative tasks in the recommendations for directors differs from the recommendations for other UNOS/OPTN physician leadership positions. The ASA included these tasks after evidence suggested that consolidated anesthesia liver transplant teams had better recipient outcomes . The study reported additional educational activities and interdisciplinary communication as key factors in improving the quality of care.…”

“…The Membership and Professional Standards Committee of the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) has approved a new bylaw recommending that each transplant center appoint a director of liver transplant anesthesia . This change is in response to evidence that anesthesiologists significantly influence liver transplant recipient outcomes and resource utilization but do not have uniform liver transplant experience or education …”