Improving timely transplantation while reducing cancellation of scheduled surgery

Organ transplant programs must mobilize perioperative resources at short notice, a stress to the system that is frequently managed by cancelling scheduled operations. We performed a quality-improvement initiative to restructure surgical services at one of the largest multi-organ transplant programs in North America (Toronto General Hospital, University Health Network, Toronto, Canada) by adapting the system developed by the Institute for Healthcare Optimization.

The resultant University Health Network Institute for Healthcare Optimization system involved (1) dedication of 2 emergency (standby) operating rooms for urgent/emergency cases and (2) revised and formalized standards to classify transplant urgency. We performed a retrospective, before-after, single-center study to measure the impact of our initiative on access to transplantation and use of operating room resources.

After the University Health Network Institute for Healthcare Optimization system was implemented, we observed a significant reduction in cancellation of scheduled surgeries per month (3% [2.4%-3.6%] vs 9% [8.1%-9.4%]; P < .001), with transplant recipients more likely to enter the operating room within the target time (P < .001 for all organ types), no increased likelihood of after-hours transplantation, and no decrease in the number of scheduled cases completed each month (715 ± 156 operations vs 729 ± 50 operations; P = .684).

The University Health Network Institute for Healthcare Optimization system has allowed our center to accommodate increasing transplant volumes without negatively impacting other surgical services.