A Quality Improvement Initiative to Reduce the Frequency of Delays in Initiation and Restarts of Continuous Renal Replacement Therapy.
Makayla Cordoza, Kristen Rachinski, Kristin Nathan and 5 others
PMID 33852528WHAT IT FOUND
Fewer CRRT initiation delays (16 to 4) and restart delays (82 to 8) occurred over 12 months after a multimodal package with RN circuit training, standard guidelines, checklists, super users, refreshers, resources, and EHR changes; no adverse events were reported.
Key findings
01CRRT initiation delays fell from 16 to 4 and restart delays fell from 82 to 8 in the 12 months after implementation.
02Restart delays fell from occurring in 93.2% of patients to 6.6% of patients.
03No adverse safety events were reported, and mean CRRT cost fell from $8,040 to $3,374 per patient.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a single health care system, so the result may not apply elsewhere. It was a before-and-after quality improvement project without a control group, and the intervention was a bundle, so the effect of any single component cannot be separated. The paper does not state the total number of CRRT patients or encounters, so delay counts cannot be turned into clear patient-level rates. The 4-hour initiation and 2-hour restart benchmarks were set by the previous dialysis agency and may have been easier to meet once RNs were already on the unit. CRRT dose and patient outcomes were not evaluated, so the project shows fewer process delays, not improved clinical results.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read fewer CRRT delays as proof that dosing or patient outcomes improved. The project did not evaluate CRRT dose or clinical outcomes, and it compared process delays before and after a bundled change.