Metrics details. The NUH transplant unit performs both heart and lung transplantations, which can be seen as competing activities. The objectives were: i To reduce the time on the lung transplant waiting list at the Nantes Transplant Unit by increasing the number of lung transplants per year twhile maintaining a 5-year survival rate above the French national average.
A quality controller was involved as the QIP referent to coach the CF quality team, analyze the pre-transplant process, and set up meaningful measures. Benchmarking was performed with other transplant units, and staff discussions were held with the Transplant Team TT to assess the outcomes of rejected donor lungs.
Negotiations were made with the hospital administration. As the only transplant center in western France, our centre provides a much needed service for transplant particularly for remote areas where traveling to Paris for a transplant is logistically complicated given the time required to arrive at the transplant center during a call. The surgery department is unique in that our surgeons at once practice lung transplants, heart transplants, and assisted circulation, as well as scheduled lung and heart surgery.
These activities compete with each other, and certain necessary choices are made, not always in favor of lung transplants. On an ethical level, we felt that it was impossible to continue to work with such a discrepancy in our waiting times, including a risk of death on the waiting list greater than the French national average. The survival of our transplant center was at stake. When we joined the QIP PHARE-M, we decided to choose an objective that was original but close to our hearts: to reduce the time on the lung transplant waiting list in Nantes by increasing the number of transplants while maintaining the quality of patient management.
The secondary objective was to improve the organization of the lung transplant access process and the quality of the waiting time for patients, both those at our CFC and those referred by other CFCs, to better prepare them and better meet their needs. A working group was formed within the CF multidisciplinary team comprising one CF coordinator nurse, one physiotherapist, two psychologists, two pulmonologists, one patient referee who had not undergone a transplant, and one quality controller in charge of coaching the group and helping it analyze pre-transplant processes.
