Thank you to all the facilities that have completed the 5-Why's RCA tool. If you have not completed and submitted the RCA tool assessment at this time, please do so as soon as possible.
Based on the RCAs that have been submitted, four common barriers were identified:
- Communication breakdowns
- Fear of the transplant process/workup
- Patient choice
Feedback from the completed RCAs, determined the lack of communication between patients, dialysis facilities, and transplant centers to determine the next steps in the process. Patients fear the lengthy workup time and process through the transplant journey. There can be difficulty in planning and attending all the scheduled appointments and requirements. The RCAs also identified decreased understanding of patient eligible criteria at transplant centers. The last recognized barrier is patient choice. Transplant as a treatment option is usually a discussion between the patient, their families, and the healthcare team; interest in transplant is ultimately a patient's choice.
Below are three suggestions of how to overcome these barriers:
- Implement a tracking tool to monitor communication from the transplant centers, dialysis facilities, and patients.
- Provide education to all patients and staff members on the United Network for Organ Sharing (UNOS) Kidney allocation guidelines
- Partner with your local transplant center to provide patient education during a lobby day event
- Discuss transplant with patients during their care plans
This month the Network is asking facilities to develop a PDSA cycle to help overcome facility specific barriers. Begin with discussing and developing a plan (the P of the PDSA cycle).
Also, during this project the Centers of Medicare & Medicaid Services (CMS) will be tracking and monitoring facilities patient population on the transplant waitlist to identity any disparities that may be present amongst patients on a transplant waitlist. CMS will focus on the following five disparate populations:
- Age (65 and older vs. 18-64)
- Ethnicity (Hispanic vs. Non-Hispanic)
- Facility Location (Rural vs. Urban)
- Gender (Female vs. Male)
- Race (Population other than White, including African American, Asian, Native American, Pacific Islander, etc. vs. White)
A priority of the Network staff is to serve as a resource to both dialysis patients and professionals throughout project activities. Open communication about existing processes, barriers, and successes is encouraged. Network staff is providing supplemental resources to assist with educating staff and patients, not adding additional burden. However, in order to assess barriers, and identify how the Network can effectively meet needs of the community, please complete the ACTION REQUIRED activities located on the left side bar of the newsletter by March 9, 2018.