Improving Time to Kidney Transplant Listing: A Single Center Quality Improvement Initiative

The process for kidney transplant listing is often lengthy and fragmented, contributing to delayed access to transplantation.

At our center, we aimed to reduce time to listing by 25% within 12 months through a quality improvement (QI) initiative.

We conducted a mixed-method QI study.

Tertiary care academic transplant center.

Adult patients listed for transplantation from January 1, 2019, to July 31, 2023.

Quantitative data were collected through chart review and qualitative data were gathered from semi-structured interviews with health care providers. Outcome measure was time from evaluation start to transplant listing and process measures included time to obtaining specific consultations and tests. Findings informed a multifaceted intervention, which included (1) improved documentation guidelines, (2) expedited access for delayed investigations, (3) a dedicated transplant nurse for Indigenous patients, and (4) an informatic-enabled coordination tool. Outcomes were then compared to those of patients listed from January 1 to July 31, 2024.

Among 109 patients in the preintervention cohort, the median time from evaluation to listing was 437 days, with only 9 patients listed predialysis. Indigenous patients, who represent over 25% of our population, accounted for only 11% of those listed. Key delays were identified in cardiology testing, colonoscopies, and mammograms. Ten health care providers were interviewed, and the main themes identified were: lack of resources, confusing task responsibilities, coordination of informatic systems and inequities affecting Indigenous patients. Following preliminary interventions, 22 patients were listed for transplant in just over 6 months-nearly one fifth of the total listed over the prior 4 years-demonstrating a marked acceleration in the listing process. Furthermore, median time to listing improved by 17% to 362 days, with a higher proportion of Indigenous patients (23%) listed and modest reductions in cardiology-related delays. Plan-Do-Study-Act cycles continue to optimize these interventions.

Conducted at a single center which limits the generalizability of findings to other health care centers. Furthermore, the timeline included the COVID-19 pandemic, which may have caused delays and influenced results independent of the QI initiative.

A multifaceted intervention addressing local challenges showed early signs of success in reducing time to transplant listing and improving access for Indigenous patients. This highlights the critical role of data-driven QI initiatives in optimizing processes and improving patient care.