310.7: Development of the Nova Scotia potential donor audit tool and historic performance database: lessons learned from the first 1000 chart reviews
Notice bibliographique
Résumé
Introduction: Adequate legislation and accountability frameworks are key components of high performing deceased donation systems. In 2021, the province of Nova Scotia, Canada, became the first jurisdiction in North America to enact deemed consent legislation. This was accompanied by government provision of frontline financial resources to support further development of program infrastructure, including implementation of means to evaluate system performance. Method: To quantitatively evaluate system performance before and after the legislative change, the provincial organ donation program, in collaboration with other key stakeholders, used an iterative design process to develop a Potential Donor Audit tool and electronic database for referral intake and manual performance audits. Retrospective chart reviews of patients in the calendar year prior to legislative change (2020) were conducted to pilot and revise the tool and evaluate missed potential donation opportunities. Results: The Nova Scotia tool was piloted on 1028 patient deaths, with limited medical record documentation of several fields including: religion (66%), ethnicity (2.8%), and gender (0%), referrals to the medical examiner (45.2%) and regional tissue bank (4.8%). Coding of free text entries for “cause of death” resulted in creation of 17 drop down categories. In total, 518 (50.4%) met clinical triggers for referral to the organ donation program; only 72 were referred (86.1% missed referral rate). Only 244 (54.7%) of 446 non-referred patients had a documented reason for non-referral. Of 163 patients meeting the Nova Scotia definition of a potential donor, 53 (32.5%) were referred, yielding 110 missed potential donors. Of these, only 6 (5.5%) had documentation of a donation discussion with next-of-kin. Reasons for non-approach were only documented in 30 (28.8%) the remaining 104 missed potential donors. Consent rates for referred patients reached 71.7% (n=38 of 53 next-of-kin approaches); reasons for next-of-kin decline were documented for all remaining patients. The actualized donation rate reported by Canadian Blood Services in 2020 was 29.9 donors per million population (n=34 donors). Conclusion: We documented a high rate of missed referral and missed potential donors in Nova Scotia in the year prior to enactment of mandatory referral and deemed consent legislation. This information supports the decision of the Nova Scotia ODP to intentionally broaden clinical criteria for referral to shift responsibility of identifying medically suitable potential donors from bedside clinicians to organ donation specialists and develop targeted educational initiatives related to these changes. Furthermore, piloting the potential donor audit tool as a part of an iterative development process was useful for creation of a data dictionary, variable modification, and workflow changes in the electronic database, yielding a tool that may be useful for other jurisdictional audits, contribution to national donor audits, and novel research programs.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,040 | 0,093 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,008 | 0,006 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,005 | 0,002 |
| Science ouverte | 0,003 | 0,003 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,004 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».