Dialyzing Wisely - Improving the Delivery of Acute Renal Replacement Therapy to Albertans

Study Overview
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Brief Summary
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Implementation of an evidence-based and best practices acute RRT pathway aiming to decrease acute RRT program and healthcare systems costs while improving important patient-reported outcomes.

Detailed Description
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Providing acute dialysis to critically ill patients in ICU settings is resource and cost intensive. The daily costs of acute dialysis can range from $528/day for intermittent hemodialysis to $865/day for continuous renal replacement therapy. Providing acute dialysis in ICU settings requires a specialized team of nurses, educators, physicians and stakeholders to ensure its safe and effective prescription and delivery. Acute dialysis is typically delivered to some of the most acutely ill patients admitted to the ICU to support organ function and sustain life. At present, there is not a standardized approach to the prescription and delivery of acute dialysis therapy in ICUs across Alberta. The DIALYZING WISELY program will implement a standardized approach to the delivery of best practices for acute dialysis therapy to all patients who receive treatment across ICUs in Alberta.

Official Title
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Dialyzing Wisely - Improving the Delivery of Acute Renal Replacement Therapy to Albertans

Conditions
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Acute Renal Injury

Intervention / Treatment
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* Other: KPI reports
* Other: Prescriber reports


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient in one of 15 adult and 3 pediatric intensive care units in Alberta Receive acute RRT as part of their usual clinical care during the intervention period Exclusion Criteria: none
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| ICU patients receiving renal replacement therapy<br>All patients in participating ICU's receiving CRRT or IRRT during the study period | Other: KPI reports<br>* Quarterly<br>* Other names: Monitoring, reporting and regular review of acute RRT KPIs;Other: Prescriber reports<br>* Individualized prescriber reports for acute RRT initiation patterns along with targeted education to ensure that align with best evidence-based practices<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Key performance indicators (KPI) | Changes in acute KPIs | Throughout intervention period up to 3 years | 
| Health system costs | Acute RRT and healthcare systems costs | 3 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Length of renal replacement therapy | Length of time patient receives RRT during their ICU stay | 3 years | 
| ICU and hospital lengths of stay | Number of days patient spends in the ICU and hospital | 3 years | 
| ICU and 90 day mortality | number of patients who die before ICU discharge or within 90 days of ICU stay | 3 years | 
| Rates of RRT dependence at 90 days | number of patients who are receiving RRT at 90 days after ICU stay | 3 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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critical care medicine, evidence based care pathway,, quality improvement, acute renal replacement therapy