Case Studies
Case studies showcase real-world applications of policies and innovations, offering insights into improving outcomes and efficiency. They enhance problem-solving skills, highlight best practices, and engage through storytelling for education and transparency.
Interest(s): , Brain Death / Death by Neurologic Criteria, Donation after Circulatory Death (DCD), Donor Management, Electronic Medical Records (EMR), Family Care, Hospital Donation Process & Education, Legal and Regulatory, NASEM Recommendations, Quality Assurance and Performance Improvement (QAPI)
Organ(s): Eye, Heart, Intestine, Islet Cells, Kidney, Liver, Lung, Pancreas, Small Bowel, Tissue, Vascularized Composite Allograft (VCA)
Patient Group(s): Adult
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Referral Proactive Rounding
Theresa
Barabash
, Life Connection of Ohio
The Challenge
Proactive Rounding in Organ Procurement: Enhancing Timely Referrals and Outcomes
Overview of Proactive (Purposeful) Rounding: Proactive rounding is a structured, intentional approach in healthcare where providers regularly check on patients to anticipate needs, prevent adverse events, and identify potential issues early . Originally adopted in nursing, medicine, and rapid response teams, this methodology is equally applicable to Organ Procurement Organizations (OPOs).
Why It Matters for Organ Donation: Organ donation cannot occur without timely referrals. A Timely Referral is defined as a notification made within one hour (or up to three hours per hospital agreement) of a clinical trigger being met. Prompt detection supports assessment of donor suitability, family dynamics, and medical history. Life Connection of Ohio (LCO) recognized missed referral opportunities in partnership with hospitals and leveraged proactive rounding to expedite Emergency Department (ED) referrals—and thereby minimize delays before ICU admission.
Referral Categories: Missed Eligible Referral: Patients aged >32 weeks gestation and <90 years meeting clinical triggers (but who did not progress to brain death), not referred to the Donation Referral Center (DRC). Missed WOLST Referral: Patients >32 weeks gestation and <70 years, meeting clinical triggers prior to planned withdrawal of life-sustaining treatment, not referred. Potential Donor: Deceased patients <75 years with at least one transplantable organ, or candidates for donation after circulatory death (DCD) who reach cardiac cessation within 120 minutes post-ventilator withdrawal (or 30 minutes for liver-only donation), per OPTN definitions.
The Approach
Process Implementation Embedded in Life Connection of Ohio’s 2022 strategic plan, the initiative began with internal training and leaders modeling this in our hospitals. We then incorporated proactive rounding into a departmental policy and work instruction. We developed a consistent documentation tool for tracking purposes. Proactive rounding fosters collaboration, raises organ donation awareness, educates hospital teams, and identifies donor potential while nurturing a culture supportive of donation. During proactive rounding we are able to explain the “why” of referrals that is more collaborative with our hospital partners. Leaders modeled rounding by engaging with unit managers, charge RNs, and clinical leads—asking targeted questions to help identify potential cases. These interactions were tracked in an Excel registry to identify trends and reinforce accountability. Despite initial resistance to transitioning from reactive to proactive interactions, continued education, donor council collaboration, and shared outcome data fostered adoption.
In April 2024, LCO extended proactive rounding to night-shift Organ Recovery Coordinators, trained and certified by the Hospital Services team—addressing data that showed most missed referrals occurred overnight. This not only provided leadership growth for Hospital Services teams but also embedded communication skills into Organ Recovery Coordinators that was a dual- purpose strategy.
The Results
Outcomes
Metric
2022
2023
2024
2025 (YTD June 30)
Timely Referral Rate
88%
66%
76%
83%
Total Referrals
3,540
4,300
4,961
2,863
ED Referrals (% of total)
99 (2%)
314 (7%)
763 (15%)
602 (21%)
Missed WOLST Referrals
154
79
44
25
Impact Summary
Established stronger hospital relationships through regular, meaningful engagement
Prevented missed referrals and significantly improved timely notification rates
Reduced missed WOLST referrals
Improved frontline clinical communication and rapport-building
Demonstrated referral volume fluctuations aligned with proactive rounding timing and staffing levels
Insights & Lessons Learned
ConclusionProactive rounding has proven its value within the OPO framework, echoing its success in broader healthcare settings. By institutionalizing proactive engagement, Life Connection of Ohio has enhanced its ability to identify donors early, fostered stronger hospital partnerships, and improved overall organ donation performance metrics.