Regional Collaborative Regional Update May 26th 2016 Dr Justin McKinlay -RCLOD Actual deceased donors- Yorkshire team DBD DCD 120 110 52 100 43 42 90 32 37 38 80 32 70 60 16 27 62 63 58 60 50 53 56 N u m b er 52 51 52 40 30 36 20 10 0 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 Year 1 April 2006 to 31 March 2016, data as at 8 April 2016 Hospitals are allocated to teams using the current team allocations, not the allocation at the time of donation Yorkshire donors, organs and transplants donors organs retrieved organs transplanted

400 370 359 364

324 326 323

297 296 300 284 268 270 257 257 254 248 248 240 235 213 200 192 N u m b er

114 103 105 90 100 88 89 83 66 69 63

0 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 1 April 2006 to 31 March 2016, data as at 8 April 2016 Hospitals are allocated to teams using the current team allocations, not the allocation at the time of donation Workforce

•New CLODS •York –Dr John Berridge •LGI (adults) –Dr Claire Tordoff •LGI (paediatrics) –Dr Catherine Penrose •Harrogate –Dr Sarah Marsh •Lincoln –Dr Gary Wilbourn •Airedale –Dr Eleanor Checkley •Mid Yorks –Dr Helen Buglass • –Drs Paul Stonelake & Andy Baker •Hull –Interviews pending for 2 posts Workforce –PA allocation

•Some Level 3 & 4 hospitals have reduced their PA allocation •Scarborough 1 → 0 •Barnsley, Rotherham, Chesterfield, Doncaster 1 → ½ Net gain 3 PA’s •Harrogate contemplating reduction

•Additional PA’s to •LTHT (2 adult, 1 paeds) •Additional PA to Hull (2 adult) •Additional ½PA Bradford

•Spare ½PA (possibly 1 PA) for simulation/secondment/regional work e.g. stretch goal/anywhere that can justify it ?? Lincoln Hospital levels Redefined

>60 potential DBD/eligible DCD per year (averaged over two Level 1 35 years) or Neuro-centre.

31-60 (rounded up) potential DBD/eligible DCD per year Level 2 34 (averaged over two years).

15-30 (rounded up) potential DBD/eligible DCD per year Level 3 55 (averaged over two years).

< 15 potential DBD/eligible DCD per year (averaged over Level 4 50 two years).

Hospital levels Redefined

• Level 1 • LTHT, STH, Hull and East Yorkshire • Level 2 • Mid Yorkshire, United Lincolnshire Hospital • Level 3 • Calderdale and Huddersfield, York Teaching Hospital, Northern Lincolnshire and Goole, Doncaster and Bassetlaw • Level 4 • Bradford, Barnsley, Chesterfield, Harrogate, Rotherham, Sheffield Children’s, Airedale Requester Pilot

•The difference detected in consent rates during the pilot is 5.4% (p= 0.12). •The original desired outcome of the pilot was to show a 10 % difference in consent rates at the 5% level of significance. •The length of the donation process was also not negatively impacted by the requester pilot. •There was no difference in the odds of consent during the pilot relative to the time period before the pilot. Requester Pilot

•Feasible with no negative impact on consent or time of the donation episode •This is not the solution to TOT20 consent issue, this is a restructuring of the SNOD workforce to avoid 24hr shifts & higher than national Nursing Average drop out (15% v. 10%).

•Implemented •Stage 1 (Q1 2015/16); Implementation Planning •Stage 2 (Q2, 3 and 4 2015/16); Full implementation of the role in 4 Regions, the order of which will be agreed within stage 1. Early planning would suggest that the regions should be North West, Yorkshire, London and Midlands. Depending on donation activity/approach tailoring the Requesters will work across regional boundaries as required. Requester Pilot

•Staff in both SN-OD and Requester roles are clear that a properly managed, resourced and supported Requester role has real value and are keen to see the role implemented •A requester should be based in a level 1 hospital and should not be the Primary SN-OD with a designated embedded role. •Implementation of the recommendations is within the existing service provision with additional band 7 posts being funded by the reinvestment of savings as released from the other project Workstreams. •Early estimates suggest that for full national implementation an additional 12 WTE posts would be required at a cost of c£660k. Simulation for Organ Donation in Yorkshire

•Work in Progress! •Existing training for paediatric ICU staff •Recently developed course (Hudds) along lines of Salford/Nottingham courses •Agenda to collaborate regionally: •Standardised training –all ICM SpRs as target audience (consultants of tomorrow at a more “influence-able”stage?) •Several centres interested -a meeting to take this forward pending •Other areas interested in specifically targeted training (e.g. Sheffield NICU) •Future aims o to harness regional collaboration yet support local enthusiasm, contribute to regional faculty and national academy

Stretch Goals

•Who knows what are stretch goals are? •Letter all chairs and CLODS sent 5th February

Dear Chairs and CLODS Other news, please keep the following dates free: 26th May – Regional Collaborative Meeting. Village Hotels, Tingley,

Sorry for the delay, as really this is a follow-up from the collaborative meeting in November of last year. 29th November – Joint Yorkshire/Lincoln, Humber and North West Regional Collaborative For the chairs benefit, the CLODS had a break out where we discussed the direction of travel for Meeting. Queens Hotel, Leeds. Yorkshire, but more importantly our region wide stretch goal. National Congress - 20th & 21st September - Warwick University campus.

As you are aware, we tried to get each donation committee interested in taking organ donation Best wishes education to schools, specifically the 6th form age group. Although this is still a goal that each committee should have on their “to-do” list, in keeping with TOT20, it hasn’t really stimulated a region wide concerted effort. I think, in time, it may become an easier target (there is a great schools pack already

developed in Scotland, the local “Be a Hero” Campaign hopes to commission educational material in the form of a video aimed at this age group, maybe one day one of the CLODs could get themselves seconded to help centralise the efforts already made and produce a “how-to” guide as well as the educational material) but at the moment we decided to concentrate on a more clinical regional stretch goal. Dr Justin McKinlay Consultant in Anaesthesia and Intensive Care Medicine

The consensus in November seemed to be: Leeds General Infirmary 1) Region wide acceptance of the ICS’s brainstem testing forms. Honorary Senior Lecturer, Leeds University. At present there are a myriad of local forms. Although practice is probably all pretty standardised and of high quality, there is now a national form, available on the ICS web site, Regional Clinical Lead for Organ Donation which should now be adopted region wide. Advantages of this is that the document goes into detail on how to do the tests so should improve practice, is a great teaching tool, is Intensive Care society approved, is standardised and therefore likely to allow rebuttal of scrutiny by any of the NORS teams visiting for the purpose of retrieval. We hope to start auditing the use and acceptance of this form (copies attached) from April for 6 months and then present this at the November collaborative.

2) Reduced DCD warm ischaemic times. There have been several talks recently in the region (Hull learning day in October, the level 1 meeting in Sheffield, and the Joint collaborative in Manchester) from the liver surgeons emphasising that for every 1 minute of warm ischaemia the incidence of biliary complications goes up by 16%. Livers retrieved in our region do not compare with those retrieved in Birmingham (personal communication Magdy Atia Liver surgeon Leeds) and it’s down to warm ischaemia times. Although extubation in theatre is likely to be the best solution to this problem, it might not be the solution for your organisation, and those institutions who already extubate in theatre can still scrutinise their processes to see if improvements could be made. Please discuss this at your committee meeting and address how, in your organisation, you can reduced DCD warm ischaemic times. As a start, data is going to be collected for each hospital’s Stretch Goals

•Adoption of ICS Brainstem testing forms •All hospitals except Bassetlaw

•Reducing Warm ischaemia times •Separate item on agenda

•Schools Project CLOD Governance forms

Significant Achievements in the last year: Regional CLOD Clinical Governance Report [Ty pe a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text

box.] Trust

Level Significant challenges/barriers in the last 12 months: Name CLOD [Ty pe a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text Name SNOD Embedded Y/N box .]

Core KPIs the last two years:

KPI Recent year Previous year BSD Testing Plans the next 6-12 months: DBD DBD · [Type a quote from the document or the summary of an interesting point. You can position the Referral Rate DCD DCD text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the DBD DBD pull quote text box.] SNOD involvement DCD DCD DBD DBD Approach rate DCD DCD DBD DBD Consent rate DCD DCD CLOD Clinical Governance Number or regional collaboratives you have attended since appointment: Organs per donor DBD DCD DBD DCD Attendance of national congress of organ donation:

Organ donation policy is in place at the Trust? Y/N Activities you have been involved at a collaborative level:

Does it follow/apply NICE guidelines? Y/N Regional CLOD suggestions - involvement - plans

Other policies/ protocols in place: •

[ Type a quote from the document or the summary of an interesting point. You can position the text box • anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text bo x.] •

•

CLOD RCLOD Organ Donation Committee: Chair appointed Y/N

Number of meetings per year:

Average number of CLOD/SNOD meetings per month:

Every CLOD -Appraisal Folders Collaborative Approach Survey

•Simon Flood –Survey Monkey •Asked for a definition of “collaborative approach” •“5 short clinical scenarios and record whether you think a SNOD was present at the formal approach” •Pilot for a national survey •Poster for Congress •Simon and Dale preparing National survey form

•Issues •No standard definition for a key KPI •(Again) do we have issues regarding communication •Call for Posters and Abstracts CLOD Calendar -Forthcoming CLOD Events Calendar

Dates Event Paul or Dale attending Other Faculty attending 2016 May 26th Yorkshire Collaborative Dale 27th South Central Collaborative Dale Malcolm Milton Hill House Milton Hill, Steventon, Abingdon, Oxfordshire, OX13 6AF June 1st Midlands Collaborative Paul Nilesh and Jonathan Concept Conference Centre in Birmingham Centre 8th South East Collaborative Paul Argy and Pardeep 8th Site Visit Warwick Dale ? Justin 9th London Collaborative Paul (Dale running Andre St Brides Foundation, Bride Lane, Fleet Nottingham hospital sim) Street, ICY 8EQ 14th NODC Paul and Dale All R-CLODs

21st SMT 28th South West Collaborative - Alex 28th National SIM Training Day 1, Nottingham Dale and Paul Dan Harvey, Chis Booth 29th National SIM Training Day 2, Nottingham Dale 8 CLODS required Dan Harvey, Martin Thomas, Malcolm Watters, Katja Empson, Andre, Pardeep, ? NW and Yorkshire CLOD Calendar -Forthcoming Collaborative CLOD Events Calendar

Dates Event Paul or Dale attending Other Faculty attending 2016 July 19th SMT (Strategic) Paul and Dale August

September 13th SMT (Strategic) Paul and Dale 20th National Congress Paul and Dale All R-CLODs 21st National Congress Paul and Dale All R-CLODs October 4th NODC Paul and Dale All R-CLODs November 8th Northern Ireland Collaborative ? Dale ? Paul Paul G 15th SMT (Strategic) Paul and Dale 15th Midlands Collaborative ? Paul ? Dale Nilesh and Jonathan 22nd South Wales Collaborative ? Paul ? Dale Chris 23rd CLOD Induction Day 1, Leeds Dale and Paul Justin 24th CLOD Induction Day 2, Leeds Dale Justin 28th - moving South Central Collaborative Dale ? Paul Malcom 28th National SIM Training Day 1, St Georges Dale and Paul Argy 29th National SIM Training Day 2, St Georges Dale and Paul Argy December 1st Scotland Collaborative ? Paul ? Dale Iain and Charles 8th Northern Collaborative Dale ? Paul Gus CLOD Calendar -Forthcoming CLOD Events Calendar

Dates Event Paul or Dale attending Other Faculty attending 2016 December 1st Scotland Collaborative ? Paul ? Dale Iain and Charles 8th Northern Collaborative Dale ? Paul Gus TBC Level 2 Meeting 2017 January 17th CLOD Induction Day 1, ? Cardiff Dale and Paul 18th CLOD Induction Day 2, ? Cardiff Dale TBC Level 1 Meeting 31st National SIM Training Day 1, Salford Dale and Paul Chris, Martin February 1st National SIM Training Day 2, Salford Dale and Paul Chris, Martin

March TBC Chair Induction