Applying lean principles to continuous renal replacement therapy processes

Benfield, C. Brett; Brummond, Philip; Lucarotti, Andrew; Villarreal, Maria; Goodwin, A.K.; Wonnacott, Rob; Talley, Cheryl; Heung, Michael

doi:10.2146/ajhp140257

Cited by 11 publications

(5 citation statements)

References 9 publications

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“…This latter impact will vary by the characteristics of a given medical center, including personnel costs and volume of CRRT care. In our medical center, we have also observed significant medical waste of CRRT solutions which we believe is in part related to a limited shelf life for use (12 hours) after manipulation for electrolyte additives . Another difficult to quantify consideration is the potential cost from adverse events should they occur.…”

Section: Special Considerations For Phosphate‐containing Crrt Solutionsmentioning

confidence: 99%

Prevention of hypophosphatemia during continuous renal replacement therapy—An overlooked problem

Heung

Mueller

2018

Seminars in Dialysis

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Hypophosphatemia is a common and potentially serious complication occurring during continuous renal replacement therapy (CRRT). Phosphate supplementation is required in the vast majority of patients undergoing CRRT, particularly beyond the first 48 hours. Supplementation can be provided either as a standalone oral or parenteral treatment or as an additive to CRRT solutions. Each approach has advantages and disadvantages, and clinicians must weigh the individual factors most relevant in their practice setting. Currently there are no consensus protocols for phosphate replacement in CRRT, and many centers replete phosphate in response to hypophosphatemia as opposed to pre-emptively. Repletion protocols have also been challenged in recent years by shortages in injectable phosphate solutions. More recently a commercially available phosphate-containing CRRT solution was approved in the United States, but there has been limited clinical experience with this product. In this review, we present recommendations for phosphate repletion in CRRT to prevent hypophosphatemia, and describe our experience using phosphate-containing CRRT solutions.

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Section: Special Considerations For Phosphate‐containing Crrt Solutionsmentioning

confidence: 99%

Prevention of hypophosphatemia during continuous renal replacement therapy—An overlooked problem

Heung

Mueller

2018

Seminars in Dialysis

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“…While mortality is an obvious metric that should be tracked, it may be difficult to ascribe survival from only one procedure in these critically ill complex patients. Given the known high mortality in this population, additional metrics examining surrogate outcomes or areas such as process of care are needed [20]. One of the few evidence-based metrics available for CRRT is the delivered effluent dose, for which it has been established target of 20–25 mL/kg/hr in adults [21–23].…”

Section: Nephrologist As Leaders For Acute Rrt Programsmentioning

confidence: 99%

Optimal Role of the Nephrologist in the Intensive Care Unit

et al. 2016

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As advances in Critical Care Medicine continue, critically ill patients are surviving despite the severity of their illness. The incidence of acute kidney injury (AKI) has increased, and its impact on clinical outcomes as well as medical expenditures has been established. The role, indications and technological advancements of renal replacement therapy (RRT) have evolved, allowing more effective therapies with less complications. With these changes, Critical Care Nephrology has become an established specialty, and ongoing collaborations between critical care physicians and nephrologist have improved education of multi-disciplinary team members and patient care in the ICU. Multidisciplinary programs to support these changes have been stablished in some hospitals to maximize the delivery of care, while other programs have continue to struggle in their ability to acquire the necessary resources to maximize outcomes, educate their staff, and develop quality initiatives to evaluate and drive improvements. Clearly, the role of the nephrologist in the ICU has evolved, and varies widely among institutions. This special article will provide insights that will hopefully optimize the role of the nephrologist as the leader of the acute care nephrology program, as clinician for critically ill patients, and as teacher for all members of the health care team.

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“…Clinical exploration has begun to address the causes associated with unplanned interruptions so as to reduce its rate of occurrence. For example, Benfield et al ( 11 ) applied lean thinking to the workflow of CRRT and confirmed that it could improve the quality of care. Sanchez-Izquierdo-Riera et al ( 12 ) applied failure modes and effects analysis to improve the safety of CRRT, and the observation group used the filter for a longer period of time than the control group.…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of a Specialized Nursing Team Intervention in the Unplanned Interruption of Continuous Renal Replacement Therapy

Zhang¹,

Hong²,

Tian³

et al. 2022

ijph

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Background: To explore the application of specialist nursing teams in patients undergoing unplanned interruptions in continuous renal replacement therapy. Methods: Sixty-six patients admitted to the intensive care unit of Jiangsu Province Hospital, China for continuous renal replacement therapy (CRRT) and experienced unplanned interruptions from Aug 2020 to Mar 2021 were enrolled as study subjects. Twenty four patients with conventional care were taken as the control group, and 42 patients in the specialized nursing team were taken as the experimental group. The age, type of disease, and degree of illness of the two groups were statistically processed and the differences were not significant (P>0.05) and were comparable. The control group received routine CRRT care after CRRT rescue, and the experimental group received CRRT care model from a specialized nursing team. Results: Patients in the group with specialized nursing care had 49 instances of CRRT unplanned interruptions, and the routine care group had 79 instances of CRRT unplanned interruptions. The number of unplanned interruptions in the experimental group was less than that of the control group, and the difference was statistically significant (P<0.001). The incidence of complications in the experimental group were lower than that of the control group (P<0.05). The satisfaction and quality of life of nurses in the specialist nursing group were clearly lower than those of the control group, and the difference was statistically significant (P<0.05). Conclusion: Specialist nursing teams could reduce the occurrence of unplanned interruptions in CRRT patients in intensive care and allow patients to receive continuity of care.

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Applying lean principles to continuous renal replacement therapy processes

Cited by 11 publications

References 9 publications

Prevention of hypophosphatemia during continuous renal replacement therapy—An overlooked problem

Prevention of hypophosphatemia during continuous renal replacement therapy—An overlooked problem

Optimal Role of the Nephrologist in the Intensive Care Unit

The Effectiveness of a Specialized Nursing Team Intervention in the Unplanned Interruption of Continuous Renal Replacement Therapy

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