Patients with chronic disease are increasingly managed by nurse practitioners and nurse prescribing affords the full completion of patient episodes in the absence of the medical team ensuring a proactive approach to patient care. In the renal services at St. Mary's Trust, it was decided to develop individualized clinical management plans to include not only those patients seen in the pre-dialysis clinic but also those patients receiving haemodialysis, peritoneal dialysis, day case procedures and transplantation.

Purpose: As the medical and surgical complexity of pediatric heart transplants (PHTx) continues to increase, individualized treatment plans are increasingly important. Given the uncertain timing of heart transplant surgeries and the involvement of several different providers, multi-disciplinary communication at the time of transplant surgery is critical to safe execution of the transplant plan. Methods: A pre-transplant flight plan (FP) and huddle (PTH) developed by Stanford University was implemented as a quality improvement project at Children's Medical Center of Dallas. The FP is a detailed pre-, peri-, and postoperative management plan developed at listing by all involved stakeholders, and updated monthly until PHTx.(Figure 1) After organ acceptance, the FP is reviewed by the on-call multidisciplinary team at a PTH. Project impact is evaluated with multidisciplinary pre-and post-implementation surveys. Preimplantation surveys included all Heart Center professionals. Professionals who participated in a huddle participated in the post-implementation survey.The key outcome metric is 30-day post-transplant survival. Results: 7 transplants included a FP/PTH, with a 30-day survival of 100%. A pre-implementation survey (n=169) indicated the minority of respondents (24%), agreed or strongly agreed that peri-transplant communication was good. Post-implementation survey (n=16) demonstrated that 87.5% agreed or strongly agreed that the FP/PTH improved multi-disciplinary peri-transplant communication, and 87.5% agreed or strongly agreed peritransplant multi-disciplinary communication was good. Conclusion: A transplant FP/PTH improves multi-disciplinary communication at the time of PHTx. Key lessons include ability to conduct PTH through virtual platform, standard data definitions, and EMR optimization for flight plan. Long-term data collection will indicate whether the flight plan improves delivery of care and/or patient outcomes.