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Expanded Liver Transplant Program Bolsters Outcomes and Communication
Date: June 13, 2014
Division director increases Division of Transplantation activity
Liver transplants at Johns Hopkins have more than doubled in the past two years, thanks in part to the vision of surgeon Benjamin Philosophe.
At the University of Maryland Medical Center, Philosophe established a reputation of evaluating new patients quickly, providing excellent care and fostering open communication with referring physicians. Since joining Johns Hopkins in October 2012 as clinical director of the Division of Transplantation, he’s applied his customer service skills here. And changes by him and his colleagues are making a difference.
In 2013, the transplant team performed 83 liver transplant operations—more than double what they had been. Physician referrals have nearly tripled, from two to three per week to eight. The active transplant list is now at 270 patients, up from 150. And one-year patient survival rates are at 93 percent—one of the highest in the country.
“We went from being a smaller, minor player to one of the larger liver transplant centers,” Philosophe says. Now, he adds, Johns Hopkins’ program is more competitive with other larger centers, “and I don’t think we’ve hit our peak yet.”
His approach started with improving access for patients, working to decrease the time between referral calls and appointments. Patients now wait, at most, two weeks before evaluation.
“I believe if a patient or physician’s office calls or sends a fax, we should see that patient no matter what,” Philosophe says. “Even if they’re not going to be a transplant candidate and even if they have issues. If they’re asking to be seen, we will see them.”
He also has worked to improve communication with referring physicians, meeting regularly with physician groups to discuss the transplant program.
“I give my cellphone number to every single doctor I can, and I encourage them to call me personally about anything,” he says. “This face-to-face contact goes a long way. They remember who you are, and they often use it.”
In addition, Philosophe recruited outreach nurse Laura Conroy to manage communications with referring physicians. Conroy monitors scheduled kidney and liver transplants and reminds surgeons to follow up with referring physicians after the operations.
“This is the kind of personal attention referring doctors love,” Philosophe says. “It’s more important to them that we give this kind of service than that we published the latest work on autoimmune hepatitis.”
Adding to the increased volumes, colleague Nabil Dagher has reinvigorated the living donor liver transplant program, which had been dormant for several years.
Dagher travels frequently to high-volume liver transplant centers to learn the latest surgical and patient management techniques. He also spends considerable time educating patients about the living donor process.
“From the moment a potential donor is identified,” says Dagher, “our program is exceptionally attuned to that person’s safety.” Each case is discussed among a team that includes a hepatologist, surgeon, transplant coordinators, living donor advocate, social worker, psychologist and nutritionist. The Johns Hopkins Hospital now performs one live donor liver transplant procedure each month, making it a medium to large center for this type of transplant.
In addition, the Department of Medicine has put new systems in place to more quickly accept hospital transfers of patients with high MELD scores (a measure of chronic liver disease that helps prioritize liver transplant candidates), evaluate them rapidly and put them on the transplant wait list, says hepatologist Ahmet Gurakur, medical director of the liver transplant program. He applauds the work of Osler residents in caring for these patients before their surgeries: “They have been pivotal in maintaining such a sick population.”