Using an Electronic Medical Record Tool to Document Transplant Option Discussions among Patients with EGFR ≤ 20 mL/min/1.73m2
1Nephrology, MAPMG, Mc Lean, VA, 2KP National Transplant Service, Oakland, CA, 3KP National Transplant Services, Oakland, CA, 4KP National Transplant Services, silver spring, MD, 5KP, Rockville, MD, 6MAPRI, MAPMG, Rockville, MD
Meeting: 2019 American Transplant Congress
Abstract number: 610
Keywords: Kidney, Kidney transplantation, Renal failure, Waiting lists
Session Information
Session Name: Concurrent Session: Quality Assurance Process Improvement & Regulatory Issues II
Session Type: Concurrent Session
Date: Tuesday, June 4, 2019
Session Time: 4:30pm-6:00pm
Presentation Time: 5:18pm-5:30pm
Location: Room 210
*Purpose: The purpose of this study, in a large integrated health system, was to improve: 1) the documentation of transplant option discussions by providers among patients with estimated glomerular filtration rate (eGFR) ≤ 20 mL/min/1.73m2 ; and 2) the number of members listed preemptively
*Methods: A new tool for documenting Transplant discussion options was implemented in the electronic medical record (EMR) and recorded as one of four categories: (a) Discussed: Interested; (b) Discussed: Not interested; (c) Not a candidate; or (d) Not discussed. Our intervention consisted of training providers and case managers how to document transplant option discussions appropriately for patients with an eGFR ≤ 20 mL/min/1.73m2. Monthly reminders were sent to providers to prompt them to fill in missing documentation.
*Results: The cohort of patients with eGFR ≤ 20 mL/min/1.73m2 as of June 2018 was 1857 and of those, 592 (32%) were in transplant continuum (referral, evaluation & waitlisted). Of those in the transplant continuum, 239 members were waitlisted of which 112 (43.2%) were preemptively listed. Of those 1290 not in the transplant continuum, 1102 did not have documentation of transplant option discussion. See attached cohort diagram & table for waitlisted patients by preemptive listing status.
In 3 months after the EMR tool was implemented, the undocumented transplant discussion improved from 1102 to 59. There were 52 new referrals of which 29 were not on dialysis yet.
*Conclusions: Tools in the EMR can help set up dashboards for individual providers to prompt them to have transplant option discussions with patients who have an eGFR ≤ 20 mL/min/1.73m2. These tools can also be used to document dialysis modality options in a searchable way. By identifying members with eGFR ≤ 20 mL/min/1.73m2 early, appropriate candidates can be preemptively listed and eventually increase the rate for preemptive kidney transplant.
To cite this abstract in AMA style:
Yishak A, Brentari RR, Clark E, Clark E, Sun J, Vupputuri S. Using an Electronic Medical Record Tool to Document Transplant Option Discussions among Patients with EGFR ≤ 20 mL/min/1.73m2 [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/using-an-electronic-medical-record-tool-to-document-transplant-option-discussions-among-patients-with-egfr-%e2%89%a4-20-ml-min-1-73m2/. Accessed May 9, 2025.« Back to 2019 American Transplant Congress