310.7: Development of the Nova Scotia potential donor audit tool and historic performance database: lessons learned from the first 1000 chart reviews
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.040 | 0.093 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.008 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.005 | 0.002 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.008 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".