Improving donation outcomes: hospital development and the Rapid Assessment of Hospital Procurement Barriers in Donation.
BACKGROUND
Deficiencies in the donation process continue to contribute to the shortage of organs available for transplant. Continuous quality improvement of hospitals' donation processes is needed to identify and correct the problems.


OBJECTIVE
To test the Rapid Assessment of Hospital Procurement Barriers in Donation (RAPiD), a direct observation technique with a focused ethnographic strategy, for assessing hospitals' donation processes and identifying areas in need of continuous quality improvement interventions.


METHODS
A pre-post assessment of hospitals' barriers to patient identification and referral, and family consent to donation.


METHODS
Seventeen hospitals within the catchment area of a Northeastern organ procurement organization were assessed by using the RAPiD method. Hospital administrators, health care providers, and staff (N = 537) were interviewed as part of the assessments.


METHODS
Interventions, including on-site training and education, and the use of in-house coordinators, were specifically tailored to each hospital's unique set of barriers to donation. The interventions were delivered to the hospitals in the form of recommendations. The participating organ procurement organization was responsible for implementation of the interventions.


RESULTS
The RAPiD hospital evaluations revealed gaps in respondents' knowledge of organ donation, brain death, and referral criteria; a reluctance to declare brain death; and a rocky relationship between the hospitals and the organ procurement organization. As a result of the interventions, 9 hospitals' environments for organ donation improved, 7 showed no change, and 1 was worse.
Siminoff
Laura A
LA
Virginia Commonwealth University, School of Medicine, Department of Social and Behavioral Health, PO Box 980149, 1112 E. Clay St., Richmond, VA 23298, USA. lasiminoff@vcu.edu
Traino
Heather M
HM
D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007373:Interinstitutional Relations; D020380:Needs Assessment / Q000458:organization & administration*; D009820:Ohio; D015279:Organizational Culture; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D010564:Personnel, Hospital / Q000193:education / Q000523:psychology; D036301:Qualitative Research; D012017:Referral and Consultation / Q000458:organization & administration; D012944:Social Support; D011795:Surveys and Questionnaires; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D017749:Total Quality Management / Q000458:organization & administration