Renal Section, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Feigin Building ,1102 Bates Ave, Suite 245, Houston, TX, 77030, USA.
Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA.
BMC Nephrol. 2019 Jan 11;20(1):17. doi: 10.1186/s12882-018-1195-8.
The prevalence of continuous renal replacement therapy (CRRT) utilization in critically ill patients with acute kidney is increasing. In comparison to published and on-going trials attempting to answer questions surrounding the optimal timing of CRRT initiation, anticoagulation, and modality, a paucity of literature describes the quality of the therapy delivered.
We conducted a single-center process improvement project to determine if a methodology to assess the quality of CRRT delivery could lead to improvement in CRRT delivery outcomes. We developed three broad categories of objective CRRT metrics to assess longitudinally, enabling creation of a CRRT Dashboard. Following the objective categories of "filter", "prescription", and "fluid balance" over time allowed us to perform quarterly analyses, target provider based CRRT education, and address variation from our standard of care. From 2012 to 2017, 184 critically ill patients received CRRT.
We report a mean filter life of 56 + 28.4 h, a 60-h filter life of 62%, and unplanned filter changes of 15%. Compared to a minimum target prescription of 2000 ml/1.73 m2/hour, we report the mean prescribed dose (2300 ml/1.73 m2/hour) and the rate of patients receiving at least the minimum prescription (98%). Finally, using a 10% deviation in the acceptable range of desired daily patient fluid balance, we report 83% CRRT patient days achieving an acceptable stipulated fluid goal.
We report the implementation of a quality dashboard and adopting quality improvement strategies provided a platform for measuring adherence to our institutional standards and the delivery of CRRT, specifically on the process of the care.
在急性肾损伤的危重症患者中，持续肾脏替代治疗（CRRT）的应用越来越普遍。与已发表和正在进行的旨在回答有关 CRRT 启动、抗凝和模式最佳时机的问题的试验相比，关于所提供治疗质量的文献相对较少。
我们进行了一项单中心的流程改进项目，以确定评估 CRRT 输送质量的方法是否可以改善 CRRT 输送结果。我们制定了三个广泛的客观 CRRT 指标类别，以便进行纵向评估，从而创建 CRRT 仪表板。随着时间的推移，根据“过滤器”、“处方”和“液体平衡”这三个客观类别进行评估，使我们能够进行季度分析、针对提供者进行 CRRT 教育，并解决与我们的护理标准的差异。从 2012 年到 2017 年，184 名危重症患者接受了 CRRT。
我们报告平均滤器寿命为 56+28.4 小时，60 小时滤器寿命为 62%，以及 15%的非计划滤器更换。与 2000ml/1.73m2/hour 的最低目标处方相比，我们报告的平均处方剂量（2300ml/1.73m2/hour）和至少接受最低处方的患者比例（98%）。最后，使用可接受的每日患者液体平衡期望范围的 10%偏差，我们报告 83%的 CRRT 患者日实现了可接受的规定液体目标。
我们报告了质量仪表板的实施和采用质量改进策略为衡量我们机构标准的遵守情况以及 CRRT 的提供提供了一个平台，特别是在护理过程方面。
