Process based quality improvement using a continuous renal replacement therapy dashboard
Process based quality improvement using a continuous renal replacement therapy dashboard
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DOI：
10.1186/s12882-018-1195-8
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发表时间：
2019-01-11
期刊：
影响因子：
2.3
通讯作者：
Basu, Rajit K.
中科院分区：
文献类型：
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作者：
Mottes, Theresa A.;Goldstein, Stuart L.;Basu, Rajit K.
背景连续性肾脏替代治疗（CRRT）在急性肾病危重患者中的使用率正在增加。与已发表和正在进行的试图回答有关 CRRT 开始最佳时机、抗凝和模式问题的试验相比，很少有文献描述所提供治疗的质量。方法我们进行了一个单中心流程改进项目，以确定评估 CRRT 实施质量的方法是否可以改善 CRRT 实施结果。我们开发了三大类客观 CRRT 指标来进行纵向评估，从而能够创建 CRRT 仪表板。随着时间的推移，遵循过滤器、处方和液体平衡的客观类别，使我们能够进行季度分析、基于目标提供者的 CRRT 教育，并解决与我们的护理标准的差异。从 2012 年到 2017 年，184 名危重患者接受了 CRRT。结果我们报告平均过滤器寿命为 56+28.4 小时，60 小时过滤器寿命为 62%，计划外过滤器更换率为 15%。与 2000 毫升/1.73 平方米/小时的最低目标处方相比，我们报告了平均处方剂量（2300 毫升/1.73 平方米/小时）以及至少接受最低处方的患者比例（98%）。最后，使用所需每日患者液体平衡可接受范围内 10% 的偏差，我们报告 83% 的 CRRT 患者天数达到了可接受的规定液体目标。结论我们报告质量仪表板的实施和采用质量改进策略为衡量对我们的机构标准和 CRRT 实施的遵守情况提供了一个平台，特别是在护理过程中。
BackgroundThe 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.MethodsWe 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.ResultsWe report a mean filter life of 56+28.4h, a 60-h filter life of 62%, and unplanned filter changes of 15%. Compared to a minimum target prescription of 2000ml/1.73m2/hour, we report the mean prescribed dose (2300ml/1.73m2/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.ConclusionWe 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.