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

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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.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Division of Nephrology, Children’s Hospital of Richmond, 1000 E Broad St, Room 5-448, Richmond, VA, 23219, USA

    Delphine R. Nelson

  2. Division of Nephrology, Ann & Robert H Lurie Children’s Hospital, Chicago, IL, USA

    Mahima Keswani, Laura Finn, Kalyn Mahoney & Lisa Genualdi

  3. Division of Critical Care, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA

    Mathew F. Barhight

Authors
  1. Delphine R. Nelson
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  2. Mahima Keswani
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  3. Laura Finn
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  4. Kalyn Mahoney
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  5. Lisa Genualdi
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  6. Mathew F. Barhight
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Correspondence to Delphine R. Nelson.

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Nelson, D.R., Keswani, M., Finn, L. et al. A quality initiative to improve recognition of fluid overload among pediatric ICU patients requiring continuous kidney replacement therapy: preliminary results. Pediatr Nephrol 38, 557–564 (2023). https://doi.org/10.1007/s00467-022-05584-4

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  • DOI: https://doi.org/10.1007/s00467-022-05584-4

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