Abstract: FR-PO119
Intensive Care Unit Improves Dialysis Care Quality While Reducing Costs
Session Information
- AKI: Outcomes, RRT
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Greenleaf Nichols, Tara E., Covenant HealthCare, Saginaw, Michigan, United States
- Doman, David M., Covenant HealthCare, Saginaw, Michigan, United States
- Mullen, Sherrie K., Covenant HealthCare, Saginaw, Michigan, United States
- Ramaiyah, Senthil P., Covenant HealthCare, Saginaw, Michigan, United States
- Rowe, Sandy, Covenant HealthCare, Saginaw, Michigan, United States
- Dunning, Stephan C., Outset Medical, San Jose, California, United States
Background
In November 2021, a medium-size hospital ICU in Michigan initiated a quality improvement dialysis program, converting their outsourced continuous renal replacement therapy (CRRT-only) to an in-house adaptive long-duration dialysis (LDD) model, using the Tablo® Hemodialysis System (Tablo) to provide treatments >6 hours, as medically necessary. This conversion was done with the goals of (1) improving quality of care for ICU patients requiring LDD, and (2) reducing both dialysis-related nursing staff burden and dialysis treatment costs. We compared patient characteristics and treatments performed in the one year before and one year after the in-house LDD program launch.
Methods
We evaluated ICU stays requiring LDD in the one year before and after the month of the dialysis quality improvement program launch. EHR data were reviewed. compiled and analyzed by ICU staff, using MS Excel. Data include, demographics, select clinical diagnoses including kidney disease, heart failure, sepsis, and COVID. The results are presented as descriptively only. No cohort adjustments or statistical significance tests were performed.
Results
There were 145 ICU stays with 13,641 hours of CRRT among 145 pts before, and 116 ICU stays with 5,098 hours of LDD among 116 pts in the year after program launch. Mean dialysis treatment hours per patient were reduced from 93.7 to 43.1, increasing ICU nurse productivity by 50.6 hours per patient. Similar dialysis treatment time savings occurred in both COVID and no-COVID subsets. Concurrently, mean ICU length of stay for these patients declined by 4.8 days between the pre and post periods, from 13.2 to 8.4 days, respectively. Mortality declined between the periods, from 60.7% to 50.9% overall, and declining in both COVID and no-COVID subsets. Total dialysis treatment costs were reduced from $1.33M to $239k, and costs per treatment hour declined 52% from $97.15 to $46.93, in the pre and post periods, respectively.
Conclusion
Converting from an outsourced CRRT-only program to an in-house adaptive long-duration dialysis program, a medium-size hospital ICU in Michigan improved dialysis care quality and patient outcomes, while reducing costs and increasing nurse productivity.