Commissioning the National Organ Retrieval ServiceKaren Quinn, Assistant Director, UK Commissioning

Background to National Organ Retrieval Service (NORS)A UK-wide network of dedicated Organ Retrieval Teams should be established to ensure timely, high quality organ removal from all donors

• Fully staffed on-call availability 24/7

• Ability to despatch a team within an hour if required

• Three hour travel to donor hospital for minimum 90%

• Responsible for all equipment, perfusion fluids, drugs and documentation for retrieval

General principle:

• The closest available team to the donor hospital is designated to retrieve

• The other teams will provide back-up if the closest team is already committed to retrieval elsewhere

NORS Introduced 1 April 2010

7 Abdominal Teams 6 Cardiothoracic Teams

Abdominal teams: Cardiothoracic teams:

Birmingham/Cardiff Birmingham

Cambridge Harefield

Kings, London Manchester

Leeds & Manchester Newcastle

Newcastle Papworth

Oxford/Royal Free, London

Multi-organ teamrgan team:

Scotland

The UK National Organ Retrieval Service

Abdominal retrieval team

Cardiothoracic organ retrieval team

Multi-organ retrieval team

NORS KPIs

1 hour muster time (target 100%)

98

98.2

98.4

98.6

98.8

99

99.2

2011/2012 2012/2013 2013/2014

1 hour mustertime

Performance is monitored via monthly KPIs and through clinical governance incident reporting

All breaches are investigated by the NORS team and the outcome is reviewed by the commissioning team

Contract breaches are subject to financial penalties (£10,000)

Performance under 100% is due to SNOD asking teams to muster later than one hour

NORS KPIs

3 hour travel time (target 90%)

92.492.692.8

9393.293.493.693.8

9494.2

2011/2012 2012/2013 2013/2014

3 hour travel time

Travel time should be within three hours on at least 90% of occasions

Slight reduction in performance since 2011 (from 94% to 93%), likely due to increasing demand and teams travelling out of zone

NORS KPIs% where 3 hour target met

0

20

40

60

80

100

2012-07to

2013-03

2013-04to

2013-09

2013-10to

2014-03

% where 3 hourtarget met

3 hour target introduced July 2012

Reasons for early stand-down are monitored

Most common reason is at the request of the recipient surgeon (commonly due to concerns about organ quality or because donor is too stable)

NORS teams are willing to wait for three hours and only stand down if the SNOD allows it

2013/14 data

• The National Retrieval Group (NRG) monitor NORS activity levels

Abdominal team activity

• 11 occasions when all 7 teams on call were out retrieving

• Activity levels vary across the teams

Cardiothoracic team activity

• Less busy than the abdominal teams

• 0 occasions when all 6 teams were out retrieving, 1 occasion when 5 teams out

• Variation in team activity levels

Example of inefficient team travels

Yes15MAY2012:05:45:0014 BasingstokeKing's

No (in Crewe)15MAY2012:05:40:0014 BasingstokeRoyal Free

Yes15MAY2012:01:30:0013 OxfordNewcastle

No (in Liverpool)15MAY2012:01:12:0013 OxfordLeeds/Manchester

No (in Chelmsford)15MAY2012:01:00:0013 OxfordCambridge

No (in Bristol)15MAY2012:00:55:0013 OxfordCardiff

No (in Harrow)15MAY2012:00:50:0013 OxfordKing's

No (in Crewe)15MAY2012:00:38:0013 OxfordRoyal Free

Yes14MAY2012:23:12:0012 HarrowKing's

No (in Crewe)14MAY2012:23:05:0012 HarrowRoyal Free

Yes14MAY2012:22:45:0010 CreweRoyal Free

No (in Liverpool)14MAY2012:22:00:0010 CreweLeeds/Manchester

Yes14MAY2012:22:00:0011 ChelmsfordCambridge

No (in Bristol)14MAY2012:21:20:0010 CreweCardiff

Yes14MAY2012:20:30:009 Bristol FrenchayCardiff

Yes14MAY2012:17:05:008 Liverpool AintreeLeeds/Manchester

Yes13MAY2012:23:25:007 KingsOxford

No (in Romford)13MAY2012:22:00:007 KingsKing's

Yes13MAY2012:18:20:005 RomfordKing's

Yes13MAY2012:17:12:006 Addenbrooke’sCambridge

No (in Addenbrooke’s)13MAY2012:16:45:005 RomfordCambridge

Yes13MAY2012:16:45:004 Birmingham Children's

Birmingham

Yes13MAY2012:06:10:003 Bristol FrenchayBirmingham

Yes13MAY2012:04:10:002 Enfield Chase FarmOxford

No (in Nottingham)13MAY2012:03:40:002 Enfield Chase FarmCambridge

Yes13MAY2012:02:41:001 Nottingham QMCCambridge

Team to attend?First notified dateDonor locationRetrieval team contacted

2

4

57

8

12

13

14

1

3 6

10

11

Out of zone

Within zone

9

• No central coordination

• SNODs are responsible for organising the organ retrieval

• No knowledge of activity across the rest of the country

What has worked well

• Improved collaboration between NORS Teams

• Achievement of one hour muster and three hour travel times

• Introduction of three hour stand down times for abdominal teams

• Nationally agreed perfusion protocol for abdominal teams

• Introduction of a tariff for consumables

What could be better

• Funding inequitable due to differing service models

• Some teams more fully utilised than others

• Ability to cope with future projected growth to meet TOT 2020

• Sustainability

NORS Review

• NORS Review agreed by NHSBT Board Sept 2013

• Independent Chair and Project Manager appointed March 2014

• Final Report presented to NORS Review Board March 3rd 2015

• Final report to come to NHSBT Board March 26th 2015

• Implementation Event May 21st 2015

Work streams

• Workforce

• Capacity

• Commissioning

• Future Service Requirements

Outcomes

• Standardised model for all NORS teams

• Realignment of current capacity

• KPIs focused on quality

• Flexibility to adapt to new ways of working

• Supported by co-ordinated despatch