Transplant Survival Follow-Up

Topic Significance & Study Purpose/Background/Rationale: Long term survivors of bone marrow transplantation (BMT) are at increased risk of chronic complications affecting almost every organ system in the body and negatively impacting quality of life. Many of these complications do not manifest until years after BMT. Early detection of these late effects is crucial as it may lessen their long-term consequences. A retrospective chart review of 28 post-BMT patients revealed only 13 (46%) received a comprehensive follow-up screening for BMT late effects. The aim of our study was to create a reliable system to improve yearly post-BMT follow up. Methods, Intervention, & Analysis: A multidisciplinary team approach utilizing The Model for Improvement was utilized. Through Failure Mode Effect Analysis (FMEA) and Pareto Analysis, the following variables were identified as those that prevented patients from receiving comprehensive post-BMT follow-up: inconsistent scheduling of long term follow up patients, variability in physician practice with deviations from evidenced-based guidelines, and lack of accountability and consistent tracking of BMT survivors. Upon evaluation of the barriers to comprehensive long term care, we completed a comprehensive review of the literature to determine the appropriate evidence-based post-BMT follow up guidelines. The following interventions were implemented: (1) creation of a standardized evidence-based follow up checklist for long term follow up patients which was approved by the medical staff; (2) standardized process to identify all BMT survivors; (3) scheduled contact of BMT survivors prior to the long term follow up visit; (4) delineated roles and responsibilities of the post-BMT follow up process; (5) accountability and regular assessment of long term follow up. Findings & Interpretation: After instituting the above aims, we increased the percentage of patients receiving complete comprehensive yearly evaluation from 46% to 100%. These interventions have been implemented into the workflow, and are the responsibility of the care managers and physician team. Discussion & Implications: Given the small number in our sample size it has yet to be shown if our initial results can be sustained. Establishing and implementing the tracking of long term patients process will further enhance the reliability and success of this project. Future work includes providing families with communication that reinforces the purpose and importance of annual comprehensive follow up post-BMT.