A Lung Transplant Clinical Pathway Proposal for the American University of Beirut Medical Center (AUBMC) Transplant Program

Abstract

Lung transplantation is the last resort, yet a breakthrough for patients with advanced lung disease, who have been worsening clinically despite optimal treatment, with a limited life expectancy. It is indicated for patients with advanced chronic obstructive pulmonary disease, interstitial lung disease, cystic fibrosis and pulmonary hypertension.

Since performing and managing a lung transplant is complex, certain guidelines have to be used to organize the process. A clinical/ care pathway, as defined by the European Pathway Association, is a dynamic step-by-step flow of an agreed set of organized care processes for a specific population during a specified period. Its purpose is to optimize the complex care delivered to this population while promoting safety and improving immediate and future outcomes.

In Lebanon, the only hospital that has performed a lung transplant is the American University of Beirut Medical Center. However, the transplant program lacks a lung transplant clinical pathway although two transplants have been already performed in the last three years. Thus, the purpose of the proposed project is the development of an evidence based, up-to-date, standardized clinical pathway for patients planned for lung transplantation.

The available literature on lung transplantation and the latest guidelines on management of the recipient peri-operatively were reviewed, as well as clinical pathways used by lung transplant programs in university hospitals. Accordingly, a clinical pathway was developed to guide the process peri-operatively, focusing on the pre-operative preparation for the surgery, the intra-operative management, ­ and the immediate post-operative plan of care up to discharge from the hospital. For each time period, the corresponding assessment activities, diagnostic tests, medications, treatments, education and consultation are emphasized.

The proposed pathway will be submitted to a multidisciplinary team for discussion and review and presented to the medical center administration for approval. Next, implementation planning with a multidisciplinary taskforce and actual integration will take place. Also, meetings will be held with the Epic team to transform the pathway into an Epic workflow. Education sessions will be given to the transplant multidisciplinary team involved in the care of these patients before launching the program.

As for the evaluation plan, process evaluation will monitor the implementation of the clinical pathway. Outcome evaluation will be done during hospital stay such as length of stay, incidence of primary graft dysfunction, and nosocomial infections. Following discharge, re-admission rates, incidence of chronic rejections, and quality of life will be monitored for the impact evaluation.

The proposed project, once implemented, is expected to standardize the care for this critical population of lung transplant recipients and promote positive patient outcomes.