The Initial Evaluation
The evaluation process is really the lifeline of your program. If not done properly, your program will lack good candidates for transplant or will have insufficient patients to transplant. This is a critical topic! In our first blog of this series, we focused mainly on what happens when a new patient is referred to your program. 
What happens once you have the records and are ready to see the patient?
In order to make the first visit as productive as possible, an effective screening method should be employed. This requires a focused review of the available medical records by the transplant coordinator to understand the patient's condition and whether or not there are any obvious contraindications to transplantation. If there are concerns, the case should be reviewed by a transplant physician before the patient is scheduled for a full evaluation. Should there remain an absolute contraindication, it is important to handle this properly with appropriate communication to everyone involved.
First, the patient needs to be notified, preferably by either the coordinator or physician who can answer and questions or concerns that the patient may have. Should the patient still want to be seen, however, the patient should be allowed to come in to meet with the transplant physician to have their concerns addressed. While this may seem to not be a productive use of clinic time, the patient will appreciate the time and consideration. Importantly for your program, the referring physician will also appreciate the extra time you spent with their patient.
Secondly, the transplant physician should make a call to the referring physician and let him know of the decision not proceed. This is particularly vital if the referring practice is new to your network to demonstrate quality of your communication and level of engagement with all patients. Remember that patient will go back to his doctor and can provide favorable feedback.
During the first visit, the patient should receive the education component of the evaluation as well as sign the consent form to acknowledge the material and proceed with the evaluation. At the first visit, each member of the multi-disciplinary team should assess the patient to determine candidacy as well as to assist in the education of the patient. Some of the assessments, for example the nutritional assessment, can be performed by a screening tool and if indicated a more in-depth interview can take place at a later date. By having the patient see the entire team, a comprehensive work-up plan can be established, saving not only the patient return trips, but also streamlining the evaluation process by making sure all necessary tests are ordered right away and allow the team to immediately discuss at the next listing meeting those patients who are clearly not candidates. This assists in compliance to make sure all patients are reviewed at the multi-disciplinary committee meeting.
Should the patient continue in the evaluation process, this will increase the likelihood that when he is presented to the team, all the necessary information and consult results will be available for review and a decision will be able to be made. Automated healthcare data management software can electronically sort and route incoming external patient documentation, which along with intelligent clinical data capture can really facilitate this process. Ideally the patient should be evaluated and a decision made in 90 days from the first appointment.
