Improving Time to Kidney Transplant Listing: A Single Center Quality Improvement Initiative

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Background: The process for kidney transplant listing is often lengthy and fragmented, contributing to delayed access to transplantation. Objective: At our center, we aimed to reduce time to listing by 25% within 12 months through a quality improvement (QI) initiative. Design: We conducted a mixed-method QI study. Setting: Tertiary care academic transplant center. Participants: Adult patients listed for transplantation from January 1, 2019, to July 31, 2023. Methods: Quantitative data were collected through chart review and qualitative data were gathered from semi-structured interviews with health care providers. Outcome measure was time from evaluation start to transplant listing and process measures included time to obtaining specific consultations and tests. Findings informed a multifaceted intervention, which included (1) improved documentation guidelines, (2) expedited access for delayed investigations, (3) a dedicated transplant nurse for Indigenous patients, and (4) an informatic-enabled coordination tool. Outcomes were then compared to those of patients listed from January 1 to July 31, 2024. Results: Among 109 patients in the preintervention cohort, the median time from evaluation to listing was 437 days, with only 9 patients listed predialysis. Indigenous patients, who represent over 25% of our population, accounted for only 11% of those listed. Key delays were identified in cardiology testing, colonoscopies, and mammograms. Ten health care providers were interviewed, and the main themes identified were: lack of resources, confusing task responsibilities, coordination of informatic systems and inequities affecting Indigenous patients. Following preliminary interventions, 22 patients were listed for transplant in just over 6 months-nearly one fifth of the total listed over the prior 4 years-demonstrating a marked acceleration in the listing process. Furthermore, median time to listing improved by 17% to 362 days, with a higher proportion of Indigenous patients (23%) listed and modest reductions in cardiology-related delays. Plan-Do-Study-Act cycles continue to optimize these interventions. Limitations: Conducted at a single center which limits the generalizability of findings to other health care centers. Furthermore, the timeline included the COVID-19 pandemic, which may have caused delays and influenced results independent of the QI initiative. Conclusions: A multifaceted intervention addressing local challenges showed early signs of success in reducing time to transplant listing and improving access for Indigenous patients. This highlights the critical role of data-driven QI initiatives in optimizing processes and improving patient care.

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