TY - JOUR T1 - Focusing on the penultimate step: increasing early lung transplant discussion in cystic fibrosis clinic to prepare patients for referral JF - BMJ Open Quality JO - BMJ Open Qual DO - 10.1136/bmjoq-2020-001031 VL - 9 IS - 4 SP - e001031 AU - Bethany L Bartley AU - Anita St. John AU - Isabel P Neuringer AU - Brian M Cummings AU - Lael M Yonker Y1 - 2020/10/01 UR - http://bmjopenquality.bmj.com/content/9/4/e001031.abstract N2 - Lung transplant is a potential life-lengthening option for individuals with cystic fibrosis (CF) and advanced lung disease. However, referral for transplant evaluation is not made for the majority of patients with CF with low lung function who die each year.1 Recently published consensus guidelines from the CF Foundation identify early transplant discussion as a critical approach to optimise access to this treatment option.2 This quality improvement (QI) intervention sought to improve education of patients with CF regarding transplant by increasing the frequency of outpatient CF clinic visits in which transplant is discussed with patients with low lung function.The setting for the QI initiative was the paediatric CF Centre at Massachusetts General Hospital. Strategies included: (1) Assembly of a multidisciplinary QI team including nursing, social work, CF providers and a transplant physician, (2) Analysis of the baseline frequency of transplant discussion between CF providers and patients with low lung function (eg, forced expiratory volume in 1 s (FEV1) ≤50%-predicted), (3) Process mapping steps to lung transplant discussion during clinic visits, (4) Survey of CF providers (n=3) to identify specific barriers to discussion in patients with low lung function, (5) Survey of patients with CF (n=6) regarding optimal timing for initial discussion, (6) Brainstorming of potential interventions using a priority pay-off matrix, (7) Creation of a web-based intervention and patient education material, and (8) Postintervention data collection and analysis using standard statistics and QI methodology.The project was undertaken as a QI initiative and was not formally supervised by the institutional review board of Mass General Brigham per their policies. Patients were involved in project design through individual interview and survey which guided the intervention.Baseline data revealed 17 patients with CF with an FEV … ER -