Improving the quality of the performance and delivery of continuous renal replacement therapy (CRRT) to critically ill patients across a healthcare system: QUALITY CRRT: a study protocol

Dawn Opgenorth, Ellen Reil, Vincent Lau, Nancy Fraser, Danny Zuege, Xiaoming Wang, Sean M Bagshaw, Oleksa Rewa, Dawn Opgenorth, Ellen Reil, Vincent Lau, Nancy Fraser, Danny Zuege, Xiaoming Wang, Sean M Bagshaw, Oleksa Rewa

Abstract

Introduction: Continuous renal replacement therapy (CRRT) is a continuous form of dialysis used to support critically ill patients with acute kidney injury. The ideal delivery of CRRT requires ongoing monitoring and reporting to adjust practice and deliver optimal therapy. However, this practice occurs variably.

Methods: QUALITY CRRT is a multicentre, prospective, stepped-wedged, interrupted time series (ITS) evaluation of the effectiveness, safety and cost of implementing a multifaceted CRRT quality assurance and improvement programme across an entire healthcare system. This study will focus on the standardisation of CRRT programmes with similar structure, process and outcome metrics by the reporting of CRRT key performance indicators (KPIs). The primary outcome will be the quarterly performance of CRRT KPIs. Secondary outcomes will include patient-centred outcomes and economic outcomes. Analysis will compare pre-implementation and post-implementation groups as well as for the performance of KPIs using an ITS methodology. The health economic evaluation will include a within-study analysis and a longer-term model-based analysis.

Discussion: The effective delivery of CRRT to critically ill patients ideally requires a standardised approach of best practice assessment and ongoing audit and feedback of standardised performance measures. QUALITY CRRT will test the application of this strategy stakeholder engagement and stepped-wedged implementation across an entire healthcare system.

Ethics and dissemination: This study has received ethics approval. We will plan to publish the results in a peer-reviewed journal.

Trial registration number: NCT04221932.

Protocol version: 1.0 (15 June 2020).

Keywords: dialysis; health services administration & management; intensive & critical care; quality in health care.

Conflict of interest statement

Competing interests: SMB and OR have received honoraria from Baxter Healthcare. The study sponsors had no role in protocol development, trial management or data analysis and reporting.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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