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UCSF Streamlines Pre-Operative and Transplant Evaluations

January 27, 2012
by John DeGaspari
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Clinical Decision Support simplifies pre-op evaluations and attracts more potential kidney donors

The University of California San Francisco (UCSF) Medical Center has significantly improved the number of potential kidney donors to its program after streamlining and automating its donor evaluation process. John Roberts, M.D., chief of the UCSF Transplant Service, says the hospital’s kidney transplant center has seen about a 40-percent increase in the number of applications from potential donors since implementing the Web-based solution (supplied by San Francisco-based MedSleuth, Inc.) that replaced paper-based forms for that purpose.

According to Roberts, UCSF has been using the Web-based system, called Breeze, for both pre-operative evaluations and for kidney transplant procedures, for more than two years. Both applications are based on the same basic platform that uses algorithms to generate a customized questionnaire to elicit a patient’s medical history.

He notes that pre-operative “prepare” meetings that allow the anesthesiologist team to conduct a risk assessment of the patient prior to surgery are both costly and time-consuming. Prior to migrating to the Web-based evaluation system, UCSF depended on generic paper-based forms and face-to-face meetings between the patient and physician or nurse practitioner—a process that was inconvenient for the patient and expensive, he says.

Generating the data electronically has allowed the hospital to save the time and expense of face-to-face meetings when they are not required, while providing the anesthesiologist team with data that is tailored to the patient’s specific condition, he says. After the initial consultation, patients are sent a link to an online questionnaire. The virtual questionnaire, which is accessed through a patient portal, uses algorithms to elicit the patient’s history, and is generated in real time based on the patient’s health profile and successive responses. The questions are presented to the patient in a point-and-click drop-down menu format and use lay terminology.

Roberts says that one advantage of the virtual form is that it allows the physician to drill down deeper with pointed questions than is possible with generic paper forms that are identical for all patients. After the questionnaire is completed by the patient, the system generates a summary that the physician uses as a basis to decide if a face-to-face meeting is needed for a patient, who may require further testing prior to surgery. UCSF estimates between 60 and 70 percent of patients can be triaged remotely in this way. “What we are trying to do is to triage patients into those who are at higher risk for anesthetic complications, and those who are at lower risk,” he says.

Roberts notes that a variation of this system has worked well for kidney transplants at UCSF, which performs about 350 of the procedures a year. In that case, both the recipient and the potential donor receive an email with the link to the online questionnaire, and both evaluated in a process similar to the pre-operative application.

“It has really streamlined the process of getting donors through the initial step of entering the system, knowing they could potentially donate if they are otherwise healthy,” he says. Recipient patients refer the potential donors to UCSF’s transplant Web site. Based on the donor’s answers on the virtual questionnaire, some—for example, people who have hypertension—are eliminated, while additional information is collected on suitable donors.

He says the Web-based system has been much more successful than paper forms. He attributes the convenience of using the virtual form to the surge in potential donors, adding that the hospital has had to make changes to its workflow to accommodate the higher numbers. “There were a number of bottlenecks that we didn’t anticipate with the increase in volume,” he says. “We want to translate that increase in volume into getting more patients transplants and off dialysis.”

In Roberts’ view, the web-based system could also be helpful in collecting information about potential recipients. “The algorithm can help us evaluate and collect information on the kidney transplant patient, so when he comes in for his first evaluation appointment, we can direct our conversation with the patient about the specific disease. Having that collected information with a summary up front would help us,” he says.

Looking ahead, Roberts believes that the system can be modified for liver transplants, which has a much smaller pool of potential donors than kidney transplants. “I would hope that we would have the same surge in the number of people who are interested in donating, who we could screen,” he says.