Transplant: Superior Services at MUSC
Guest: Dr. Kenneth Chavin - Surgery
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I am Dr. Linda Austin. I am interviewing Dr. Kenneth Chavin who is Professor of Surgery, Immunology, and Microbiology here at the Medical University of South Carolina.
Dr. Chavin, the medical university was just honored through you work and the work of some of your colleagues to be listed as the number one, top, liver transplant service in the country. Dr. Chavin, the name of the organization that gave you and the university this high honor of naming you the number one liver transplant service in the country was what?
Dr. Kenneth Chavin: The University Health Consortium, or UHC.
Dr. Linda Austin: And what were the factors that they looked at? Why did they pick your service as number one?
Dr. Kenneth Chavin: Well, it is a survey that is done quarterly based on university-based hospitals that takes into consideration patient outcomes, including morbidity, mortality, survival rate, the patient, the graphs, length of hospital stay, complications, pharmaceutical costs, and puts all those together in a formula for what is predicted for the average patient with their degree of illness and how these different universities compare. And as a result of outcomes and all, we were ranked number one out of all the universities that are participating in this survey.
Dr. Linda Austin: So it is really data-based then. This is not patient satisfaction. It is the hardcore data, really, it sounds like.
Dr. Kenneth Chavin: It is. It is the real outcomes data.
Dr. Linda Austin: How long have you been here at the medical university and how long have you been doing liver transplants?
Dr. Kenneth Chavin: This is my second stint here at the medical university. I actually came as part of my residency and was pursuing a PhD in the middle. I got my PhD here in the middle of General Surgery Residency. I finished my general surgery in 1996 and then went off to fellowship training at Johns Hopkins and have been back on staff since 1998. So, I have been participating in our transplant service since 1998 as a full attendant.
Dr. Linda Austin: Who are your other colleagues who are part of this team?
Dr. Kenneth Chavin: Well, it is a multidisciplinary team that includes the surgeons, hepatologists, operating room anesthesiologists, nurses, nurse coordinators, pharmaceutical services, infectious disease, as well as pathology. It is a multidisciplinary approach to the care of the transplant patient prior to surgery, during surgery, hospitalization, as well as after he/she is discharged from the hospital.
Dr. Linda Austin: I am sure that you and your fellow surgeons have had some very specific initiatives, or goals, in this program that have allowed you to improve to the point that we are ranked number one now. What have been some of your primary target areas to look at?
Dr. Kenneth Chavin: What we have done on a monthly basis is, for each of the abdominal organs, we have a quality improvement group that gets together and has representatives from all those different components that make up the transplant process. What we have targeted is to try to be the most efficient at the way we deliver the care to the liver failure patient, as well as the post-transplant patient. So, we have targeted how to educate them better, how we go through our selection process so that we optimize their coming to the surgery and in the period after the surgery. We have developed nursing pathways so that there are certain benchmarks that our patients should be at, at this point in their care, and everyone gets that same care. We have protocols that we use to make sure that it is individual-based to the patient’s needs but, at the same time, taking a strong review of the literature and applying that to what the best practices are. We apply that and review, monthly, why certain patients fell off that, what we could have done to improve and apply that as we go forward.
Dr. Linda Austin: So, obviously, this success did not just happen. It was really the result of taking the whole process apart, dissecting it piece by piece and trying to optimize the quality for the patient’s care and recovery, piece by piece?
Dr. Kenneth Chavin: I would say, yes. One of the unique things, at least I believe, to us is that we meet monthly to approach and see what the outcomes of our intervention were, as well as quarterly and yearly. So, it has been progress over time in terms of how it all has come together to, at this point, make us number one by all of those different benchmarks. It is not a single thing we have targeted but, globally, looking at the program and addressing it in a multidisciplinary approach and, at every phase of the process, doing it as a team.
Dr. Linda Austin: Let’s look at your survival data, if we can. When you look at those statistics, can you tell us what they are? What are some of the measures that you look at and how have we been doing recently?
Dr. Kenneth Chavin: The data that has most recently been analyzed, from our last 56 liver transplants, by the UHC showed that our length of stay was approximately eight and a half days. What was expected for the severity of illness was approximately 13 days.
As far as our survival, we were about one percent lower than expected. Ninety-eight percent of the patients did well. What was expected was closer to about 94 percent. So, based on those parameters and others that they capture, when you compare them to all the other programs that were analyzed, that is how we ended up with the best survival for our time period.
Dr. Linda Austin: So, is it fair to summarize then that by saying that our patients are staying in the hospital significantly shorter periods of time, five days or so, and that rather than having a six percent mortality, we have a two percent mortality?
Dr. Kenneth Chavin: Yes.
Dr. Linda Austin: That is quite impressive.
Dr. Kenneth Chavin: We were pleased.
Dr. Linda Austin: I bet you were. And I understand that we have the shortest waiting list in the country as well.
Dr. Kenneth Chavin: Currently we have the benefit, also, of having one of the best organ procurement agencies in the country and our patients on the waiting list have the shortest waiting time for liver and kidney in the country right now. So, definitely, that would alleviate their degree of illness at the time and their ability to get a good organ in a timely fashion for a good outcome. So, that definitely adds to how we have been successful at this.
Dr. Linda Austin: In other words, because the waiting list is shorter, you have healthier patients going into surgery who might be more able to do well?
Dr. Kenneth Chavin: The data, though I have not seen the most recent, says that we, here in South Carolina, do a MELD (Model for End-Sage Liver Disease), which is the scoring system that is used universally across the country and our average MELD is 22 to 24. And some of the major cities where they do not have as many organs but have millions of people, like New York or San Francisco have MELDs closer to 35 or 40 because they have just lists of hundreds of people in those cities, because there are millions of people. South Carolina has a little over four million people and being a single transplant center that serves that population, our residents of the state definitely benefit from that opportunity.
Dr. Linda Austin: So, the MELD, then, is a measure of how sick the patients are? Is that right?
Dr. Kenneth Chavin: It is a mathematical, calculated, formula to compare patients and to stratify who is the sickest to qualify for the next organ, so, yes.
Dr. Linda Austin: Now, one final question, you are a professor not only of surgery but also immunology and microbiology, clearly, transplant surgery involves a lot of immunology, do you bring to bear that training in the work you do?
Dr. Kenneth Chavin: Part of why I do what I do and why I got my PhD was to look for ways of translating basic science to the clinical arena. We are fortunate to have an NIH (National Institutes of Health) grant looking at ways to use livers that others would not use, specifically ones that have a higher fat content, to use them instead of allowing them to be discarded. So, a focus of our research has been to look at ways of altering those livers or improving the operation itself, to use those livers instead of discarding them. And we have had very good success in using livers that others would not use through the study at the bench and we apply that on a daily basis in our decision tree and how we go about who gets a transplant.
Dr. Linda Austin: Thank you so much and good luck with your work.
Dr. Kenneth Chavin: Thank you.
If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection: (843) 792-1414.