A quality initiative to improve recognition of fluid overload among pediatric ICU patients requiring continuous kidney replacement therapy: preliminary results

Delphine R. Nelson*, Mahima Keswani, Laura Finn, Kalyn Mahoney, Lisa Genualdi, Mathew F. Barhight

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Initiation of continuous kidney replacement therapy (CKRT) greater than 20% fluid overload is associated with increased morbidity and mortality. We aimed to reduce the number of patients initiated on CKRT greater than 20% fluid overload by 50% in one year by implementation of a quality improvement initiative. Methods: This is a prospective quality improvement study set in a pediatric ICU of an urban children’s hospital of patients initiated on CKRT over 2 years. The intervention included creation of an electronic health record order for daily calculation of net percent fluid overload, incorporation into daily rounds, and education programs tailored to physicians and bedside nursing. We measured adherence with the new order set, percent fluid overload at CKRT initiation, days on CKRT, timing of first nephrology consultation, and death prior to discharge. Results: A total of 32% of patients were initiated on CKRT greater than 20% fluid overload pre-initiative and 9% post-initiative, a 72% reduction over 13 months. Patients initiated on CKRT greater than 20% fluid overload had median CKRT course of 8 (IQR 4–14) vs. 22 days (IQR 13.5–62). Conclusion: Creating a system using EHR with education may reduce initiation of CKRT after development of severe fluid overload. Graphical abstract: A higher resolution version of the Graphical abstract is available as Supplementary information. [Figure not available: see fulltext.].

Original languageEnglish (US)
Pages (from-to)557-564
Number of pages8
JournalPediatric Nephrology
Volume38
Issue number2
DOIs
StatePublished - Feb 2023

Keywords

  • Acute kidney injury
  • Continuous KRT
  • Education
  • Electronic health records
  • Mortality
  • Quality improvement

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health

Fingerprint

Dive into the research topics of 'A quality initiative to improve recognition of fluid overload among pediatric ICU patients requiring continuous kidney replacement therapy: preliminary results'. Together they form a unique fingerprint.

Cite this