Who Needs the Referral Data, for What Decision and by When: A Department-by-Department Analysis of the Organ Donation Referral Workflow
[Student Name]
University of Phoenix
NSG/542: Information Workflow
Week 3 Assignment
[Instructor Name]
[Date]
The hospital, its departments and all data are a composite written for a model paper.
In Week 2, I mapped the current referral workflow in our intensive care unit and found five failure points, from triggers documented but not recognized to referral numbers written on sticky notes. This paper asks who needs the data that this workflow produces, for what decisions and by when, and where the workflow falls short.
Why Begin With Decisions
A department's data needs follow from its decisions. The organization's coordinator decides whether to come to the hospital; the quality department decides whether the hospital is compliant; the unit manager decides whether staff need education. Each decision needs specific data at a specific time, and data that arrive late or incomplete are, for that decision, the same as no data. Asking what each user decides, rather than what each user wants, keeps the analysis from producing a list of everything.
User 1: Bedside Nurses and Charge Nurses
Decision: whether a patient meets a referral trigger now and whether a referral has already been made.
Data needed: current Glasgow Coma Scale score, ventilator status, orders or notes about goals-of-care discussions or brain death evaluation, and the referral status with time and number.
Timing: within minutes, at the bedside, while caring for the patient.
Current supply: scores are in the flowsheet and goals-of-care orders in the order list, but nothing displays them together or flags a trigger, and referral status is visible only if someone has written a note. In the missed cases, nurses did not know whether a referral had been made.
User 2: Intensivists and Attending Physicians
Decision: when and how to hold the family meeting, and whether to coordinate it with the organization.
Data needed: whether a referral has been made and whether the organization plans to be present.
Timing: before the family meeting.
Current supply: none; physicians learn of referrals by word of mouth. Coordinating the conversation matters because research on donation decisions has found that families' contact with organization staff and the conversations they have are associated with consent (Siminoff et al., 2001).
User 3: The Organ Procurement Organization
Decision: whether the patient may be a donor and whether to send a coordinator.
Data needed: demographics, diagnosis, neurologic status, ventilator settings, hemodynamics, key laboratory values, plans for goals-of-care discussion and family contact information.
Timing: at referral and updated as the situation changes.
Current supply: delivered by phone from memory or the screen, sometimes by a clerk who cannot answer clinical questions; coordinators then review the record on site or by remote access, which requires a separate access request each time.
User 4: Chaplains and Social Workers
Decision: when to offer support to the family and whether donation is being discussed, so they do not raise it prematurely or contradict the plan.
Data needed: referral status and the planned time of the family meeting.
Timing: before contact with the family.
Current supply: learned informally at huddles.
User 5: Decedent Affairs
Decision: whether a death has been referred for tissue and eye evaluation before the body is released.
Data needed: time of death and referral status for tissue and eye.
Timing: before release to the funeral home.
Current supply: a paper checklist completed by the nurse at death; in the 11 missed tissue referrals, the box was left blank and no one checked it before release.
User 6: The Quality and Regulatory Department
Decision: whether the hospital meets its referral obligations and where improvement is needed.
Data needed: every patient meeting a trigger, the trigger time, the referral time, the referral number, the outcome and, for all deaths, the tissue and eye referral.
Timing: monthly, and immediately for any missed referral that may need review.
Current supply: assembled by hand from the organization's monthly report and chart review, taking about eight hours a month. The hospital's obligations under the conditions of participation include timely notification of imminent deaths and deaths (Condition of Participation: Organ, Tissue, and Eye Procurement, 2023), so the department needs a complete record, not a sample.
User 7: Unit Leadership and Education
Decision: which staff need education and whether changes are working.
Data needed: referral timeliness by unit, shift and role, and the reasons for delays.
Timing: monthly.
Current supply: none at the unit level; the quality report gives hospital totals.
Gap Summary
The analysis produces five gaps. First, trigger data exist but are not assembled or flagged for the people who must act. Second, referral status, time and number are not captured in a structured field, so no one can see whether a referral happened. Third, clinical data reach the organization by phone and memory rather than a standard summary. Fourth, tissue and eye referral for all deaths depends on a paper box no one checks. Fifth, quality and unit data are assembled by hand, late and without reasons for delay.
How Needs Were Confirmed
The data needs were not assumed. Each user group reviewed its row of the analysis: two charge nurses, an intensivist, the organization's hospital liaison, a chaplain, the decedent affairs coordinator, the quality manager and a unit manager. Three changes came from that review. The organization asked for family contact information to be included, since coordinators lose time finding it. Decedent affairs asked for referral status to appear on its release checklist rather than in the chart. And the quality manager asked for a reason field when a referral is late, so that the department can learn why rather than only count.
Priority
The gaps are not equal. The first two cause most missed and late referrals; the third slows the organization's response; the fourth causes the tissue failures; and the fifth prevents learning. Unertl et al. (2010) describe outcomes as part of workflow, and the outcomes here, lost chances for families and compliance findings for the hospital, follow most directly from the first two gaps, which the redesign in Week 4 will address first.
Minimum Necessary Data
Not every user needs every data element. Chaplains need referral status and meeting time but not laboratory values; decedent affairs needs referral status but not the clinical summary. Limiting each user's view to what its decisions require protects patient privacy and keeps screens uncluttered, and it will shape the distribution plan in Week 6.
Timing Across Users
Laid side by side, the users' timing needs form a sequence: nurses and physicians need data within minutes, the organization within the hour, chaplains and decedent affairs within hours and quality and leadership within weeks. Any redesign must meet the fastest needs in real time and can meet the slower ones through reports.
Conclusion
Seven users depend on data from the referral workflow, each for a specific decision at a specific time. The current workflow meets few of those needs: triggers are not flagged, referral status is not recorded in a structured way, clinical data travel by phone, tissue referral depends on paper and quality data are assembled by hand. These five gaps define what the redesigned workflow must deliver.
References
Condition of Participation: Organ, Tissue, and Eye Procurement, 42 C.F.R. ยง 482.45 (2023).
Siminoff, L. A., Gordon, N., Hewlett, J., & Arnold, R. M. (2001). Factors influencing families' consent for donation of solid organs for transplantation. JAMA, 286(1), 71-77. https://doi.org/10.1001/jama.286.1.71
Unertl, K. M., Novak, L. L., Johnson, K. B., & Lorenzi, N. M. (2010). Traversing the many paths of workflow research: Developing a conceptual framework of workflow terminology through a systematic literature review. Journal of the American Medical Informatics Association, 17(3), 265-273. https://doi.org/10.1136/jamia.2010.004333
How this NSG 542 Week 3 example is structured
The NSG/542 description stresses knowing what data will be needed by various departments within the organization. This paper builds the analysis around decisions: for each user it names the decision, the data elements and the timing, then compares need with what the current workflow provides, producing a gap list that the redesign must close. Students search this week as NSG 542 Week 3, NSG542 Wk 3 or NSG/542 Wk 3; all three are the same assignment.
NSG/542 Week 3 questions, answered
What does NSG/542 Week 3 usually ask for?
The course description stresses knowing what data various departments need. Many sections ask students to analyze the data needs of each department in their workflow and where the current process fails to meet them.
Why organize data needs by decision?
Because data are useful only when they inform a decision. Tying each data element to a decision and a deadline shows which gaps matter most.
Does the organ procurement organization receive patient data?
Yes. Federal privacy rules permit hospitals to disclose protected health information to organ procurement organizations for the purpose of facilitating donation, but disclosures should still be limited to what is needed.
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