1. Herbage Busch, Ann RN, MS, CWOCN, ACNS-BC, CNS-PP
  2. Brenk, Thomas MPA

Article Content


The Veterans Affairs (VA) Electronic Transplant Referral Template was developed to facilitate, standardize, and expedite the referral process in the VA system nationally.



The template relieves transplant coordinators from manually sorting through an electronic chart for pertinent provider notes and clinical data to make a referral. The template streamlines the process for referral, facilitates more timely patient access to transplant care, improves the efficiency and timeliness of referrals, and expands opportunities for data collection.



Over 1,500 transplant referrals are made in the VA system each year. Historically, the referral process has been cumbersome and viewed as a barrier for patient referral. A coordinator at each VA utilized a checklist to gather pertinent data from the electronic record, assembled the pages in required order, obtained signatures, and sent the referral to VA Central Office for an expert panel of transplant physicians to review.



As an internal consultant, the liver transplant clinical nurse specialist (CNS) collaborated with her local VA computer (CAC) expert to translate the existing referral system to an electronic process. The electronic template pulls required information in the correct order. Demographics, progress notes, labs, imaging, and procedure results are uploaded into the template and are viewed in the electronic chart together. The prototype was developed locally, piloted at 13 VA sites, and revised from pilot and national VA leadership feedback.



The template is currently being rolled out nationally to all VA hospitals and clinics. Referral coordinators report they save a minimum of 2 hours per referral, have packets that are reduced in size from greater than 50 pages to 15, and improve patient care by expediting referral.



Collaboration between CNS at the point of care, local CAC, and national VA leadership resulted in developing the national VA Electronic Transplant Referral Template. This template maximizes the use of electronic charting capabilities to streamline the referral process resulting in improved care for patients referred for transplant.


Implications for Practice:

Significant nursing time is saved using an improved product. This template organization could be used by other healthcare systems that utilize electronic records.


Section Description

The 2010 National Association of Clinical Nurse Specialists (NACNS) Annual National Conference is planned for Portland, Oregon, on March 3 to 6. More than 375 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are expected to attend. This year's theme, "CNS as Internal Consultant: Influencing Local to Global Systems," demonstrates the breadth and depth of CNS practice and leadership at multiple levels in organizations and on healthcare.


A total of 142 abstracts were submitted for review, and 58 (not including student posters) were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session; student abstracts will appear in a later issue of the journal. The abstracts addressed CNS practice in all 3 practice domains as described in the Spheres of Influence Framework for CNS Practice. Abstracts emphasized patient safety and quality care outcomes, leadership, CNS education, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into the 3 Spheres of Influence, the role of the CNS in developing clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, the role of the CNS in National Database for Nursing Quality Indicators (NDNQI) activities, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNS's contribution to the well-being of individuals, families, and communities, as well as contributing to the advancement of the nursing profession.


The conference abstracts are published to share new knowledge with those unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics.


Watch for next year's call for abstracts and consider submitting for presentation at the next NACNS annual conference scheduled for March 9-12, 2011, in Baltimore, Maryland.