116.6: Breaking Down the Barriers to an Improved Consent Rate - an Australian Hospital’s Journey.

Background: Since 2009 the Australian government has implemented a world’s best practice system to improve access to solid organs for transplantation. This initiative included specific funding for activity and staff at hospitals throughout Australia. The Royal Melbourne Hospital has historically had low rates of consent for organ donation. In 2014 this sparked a review and transformation of local processes to improve organ donation consent rates and ultimately organs for transplantation. Methods: The RMH is one of two adult metropolitan tertiary trauma centres for Melbourne. It has a range of specialty services including specialist neurosurgical and stroke services. This paper describes the major process changes that have been implemented over the last 5 years, and the associated changes in consent rates. Results: During the last 5 years there were 5 key process changes that occurred. They included; The implementation of donation specialist nursing coordinators into the hospital setting Local auditing of data and feedback to ICU staff Mandatory donation conversation communication training for all senior staff Embedding of a donation specialist nurse or doctor at the core of end-of-life conversations Implementation of a best practice culture These 5 interventions have been associated with a significant increase in consent rates over the study period (38% vs 78%, p = <0.01). Together with a growth in the number of referred patients, these process improvements have seen in increase in the number of transplant recipients from 29 in 2014, to 135 in 2018 from this single centre. Conclusions: 5 key interventions have been associated with a statistically and clinically significant improvement in donation consent rates, resulting in improved access to solid organ donation for transplantation.