(321) Respiratory Therapy Timeout Prior to Terminal Extubation Improves Institutional OPO Performance

Introduction: Ensuring the opportunity for organ donation at end of life is a critical responsibility of high-functioning ICUs. Missed referrals to the institutional Organ Procurement Organization (OPO) are driven in part by terminal extubations without OPO notification and are considered a “never event.” We hypothesized that implementing a respiratory therapy (RT)-driven "time-out" before terminal extubation, included in our institutional end-of-life (EOL) order set, would lead to a decrease in missed OPO referrals.

Methods: Respiratory Therapy (RT)-driven time-outs were implemented in all four critical care units of our institution in September 2022. Specifically, an RT communication order was integrated into the existing EOL order set, mandating a formal time-out prior to terminal extubation between nursing and RT. This time-out confirms that the purpose of extubation was communicated to OPO and that OPO had signed off. We analyzed the number of missed OPO referrals before and a􀅌er September 2022. We used a linear regression model to predict the intervention’s impact from pre- to post-implementation and reported coefficients with 95% confidence intervals. We also examined the change in missed referrals using line plots, predicted margins, and margin plots. Statistical analyses were conducted using STATA v18, with significance set at p ≤ 0.05.

Results: The mean number of missed referrals was 5.11 during the pre-intervention period and 1.22 during the post-intervention period. There was a significant reduction in missed referrals from pre- to post-implementation (B = -3.89, 95%CI [-6.52, -1.25], p = 0.005). There were no significant differences between the years 2021 and 2022. However, there was a significant decrease of -3.64 referrals when comparing 2023 to 2021 (p = 0.043). The most substantial and significant decrease in missed referrals occurred during the fourth quarter of 2022 (B = -9.88, 95%CI [-16.31, -3.45], p = 0.004).

Conclusions: Implementing RT-driven "time-outs" before terminal extubation effectively reduces the number of missed OPO referrals and contributes to improved institutional OPO performance.