A study protocol for improving the delivery of acute kidney replacement therapy (KRT) to critically ill patients in Alberta - DIALYZING WISELY

Dawn Opgenorth, Sean M Bagshaw, Vincent Lau, Michelle M Graham, Nancy Fraser, Scott Klarenbach, Louise Morrin, Colleen Norris, Neesh Pannu, Selvi Sinnadurai, Shelley Valaire, Xiaoming Wang, Oleksa G Rewa, Dawn Opgenorth, Sean M Bagshaw, Vincent Lau, Michelle M Graham, Nancy Fraser, Scott Klarenbach, Louise Morrin, Colleen Norris, Neesh Pannu, Selvi Sinnadurai, Shelley Valaire, Xiaoming Wang, Oleksa G Rewa

Abstract

Background: Acute kidney replacement therapy (KRT) is delivered to acutely ill patients to support organ function and life in the Intensive Care Unit (ICU). Implementing standardized acute KRT pathways can ensure its safe and effective management. At present, there is no standardized approach to the management of acute KRT in Alberta ICUs.

Methods: Dialyzing Wisely is a registry embedded, stepped-wedge, interrupted time-series evaluation of the implementation of a standardized, stakeholder-informed, and evidence-based acute KRT pathway into Alberta ICUs. The acute KRT pathway will consist of two distinct phases. First, we will implement routine monitoring of evidence-informed key performance indicators (KPIs) of acute KRT. Second, we will provide prescriber and program reports for acute KRT initiation patterns. After the implementation of both phases of the pathway, we will evaluate acute KRT performance quarterly and implement a customized suite of interventions aimed at improving performance. We will compare this with baseline and evaluate iterative post implementation effects of the care pathway.

Discussion: Dialyzing Wisely will implement, monitor, and report a suite of KPIs of acute KRT, coupled with a care pathway that will transform the quality of acute KRT across ICUs in Alberta. This program will provide a framework for scaling evidence-informed approaches to monitoring and management of acute KRT in other jurisdictions. We anticipate improvements in acute KRT performance, decreased healthcare system costs and improved patient quality of life by decreasing patient dependence on maintenance dialysis.

Trial registration: Clinicaltrials.gov , NCT05186636. Registered 11, January, 2022.

Keywords: Acute renal replacement therapy; Care pathway integration; Critical care medicine; Intensive care.

Conflict of interest statement

We confirm there are no conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

We confirm we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication with respect to intellectual property. In doing so we confirm that we have followed the regulation of our institutions concerning intellectual property.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Care Pathway for Dialyzing Wisely
Fig. 2
Fig. 2
Outline of learning health system knowledge to action framework. The healthcare system data are used to set local priorities for improvement. Data on priority problems and potential contributors help find the evidence based solutions to improve local health systems (data to knowledge). Using evidence based knowledge, this will inform local quality improvement and implementation science guided efforts (knowledge to performance). Finally, the continuous monitoring of local KPIs and practices will develop practice based knowledge while revealing future opportunities for quality improvement (performance to data). Adapted from Kilbourne et al. [16]
Fig. 3
Fig. 3
Outline of Structure-Process-Outcome framework. The framework of elements which constitute each standardized acute dialysis program is depicted above. While themes remain consistent between programs, each program may use specific elements which work best within their own processes
Fig. 4
Fig. 4
Project governance and roles structure. *Stakeholders will fill the role of Leadership and Educational leads for each Acute Dialysis program, fulfilling the Structure KPI Requirements in Dialyzing Wisely. All project committees will be supported by the Program Manager and Research Assistant. Key reporting and educational messaging will be facilitated by Knowledge Translation Specialists

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