Association of Standardization of Continuous Renal Replacement Therapy and High-Value Care

Abstract

Continuous renal replacement therapy (CRRT) is an essential tool in the management of renal failure in patients who are critically ill. Though its utilization has increased globally, it is a resource-intensive, costlier modality of dialysis. [1][2][3][4] Furthermore, its usage is highly variable owing to the heterogeneity of patients and physicians, as well as the paucity of evidence to guide practice. 5 These characteristics make it a prime target for high-value care through standardization of practice. At our institution, we assessed utilization patterns of CRRT and established evidence-based guidelines to standardize process flow and promote meaningful use.Methods | A multidisciplinary task force was organized in October 2015 to assess CRRT utilization patterns. Interventions were implemented throughout fiscal year (FY) 2016, including the creation of evidence-based guidelines that: (1) clarified each physician's role in the initiation, maintenance, and cessation of CRRT; (2) defined indications to start therapy with a focus on patient goals of care; (3) described situations where CRRT would be medically inappropriate; (4) mandated daily cross-disciplinary communication between medical teams and key stakeholders; and (5) provided guidance on discontinuing CRRT. Additional measures to minimize excess laboratory tests and promote awareness of CRRT were also implemented. Comparisons between preintervention (FY 2014(FY -2015 and postintervention (FY 2016(FY -2017) cohorts were made with the independent samples t test for continuous variables, and Pearson

Standardization of Continuous Renal Replacement Therapy

“…The authors have noted that both the average duration of CRRT treatment and the average direct cost of CRRT decreased overall . This is an important finding, especially when dealing with a large patient volume.…”

“…To the Editor We read with great interest the article by Tseng et al discussing the importance in taking an evidence-based approach to treating critically ill patients with renal failure. We would like to laud the authors for pursuing high-value care with a resource-intensive treatment modality such as continuous renal replacement therapy (CRRT).…”

Impact of protocolized fluid management on electrolyte stability in patients undergoing continuous renal replacement therapy

“…Various studies have been conducted to improve the quality of CRRT operation and to develop standardized guidelines ( 17 , 18 ). An evidence-based approach and multidisciplinary communication on CRRT application were reported to reduce the duration of CRRT and medical costs ( 19 ). We have developed a CRRT fluid protocol prescribing dialysate and replacement fluids according to levels of serum electrolytes focusing on phosphate and potassium.…”