Transitioning from night to day transplants: changing the transplant culture for optimisation through a province-wide quality improvement initiative.

Abstract

Background: Organ transplants, some of the most complex operations, have historically been performed overnight due to logistical challenges in healthcare systems. Overnight transplants contribute to transplant team burnout and can compromise patient outcomes. A province-wide quality improvement (QI) initiative was launched to increase the daytime operation rate to ≥80%.

Methods: The project was launched in July 2020 by the Daytime Transplant Working Group, including stakeholders from the Organ Donation Organization, donor hospitals, and the two recipient hospitals to increase daytime transplants, as defined by operation start time between 07:00 and 14:00 for donor operations and 08:00 and 18:00 for recipient operations. Organ donor and recipient operation start times were collected from January 2019 to June 2020 (control period), July 2020 to December 2021 (intervention period) and January 2022 to December 2023 (maintenance period). Data were analysed using p-charts on SQCpack V.7 (PQ Systems, Dayton, OH).

Results: From 696 retrieval operations, a total of 458 liver transplants, 295 lung transplants, 126 heart transplants and 1122 kidney transplants were performed. Our ≥80% target was met for liver, lung, and heart transplants; however, there was no change in kidney transplants. Daytime rates of organ donor operations increased but did not achieve the ≥80% target.

Interpretation: Despite the COVID-19 pandemic impacting OR access during the intervention period, the target of ≥80% daytime operations was achieved for liver, lung and heart transplants by engaging donor and recipient hospitals. The transition to daytime surgery was improved with a dedicated team to systematically address barriers and concerns from donor hospitals.