Oleksa Rewa is a critical care and internal medicine physician by training, practicing at the the University of Alberta Hospital General Systems Intensive Care Unit and the Sturgeon Community Hospital Intensive Care Unit.
His focus of research is in critical care nephrology, with a particular focus on renal replacement therapy in critical ill patients and improving the quality of care delivery to patients undergoing continuous renal replacement therapy.
ABSTRACT: Acute kidney injury (AKI) is a common occurrence in the intensive care unit. Treatment is largely supportive; however when kidney failure occurs, kidney dialysis is often necessary and continuous renal replacement therapy (CRRT) is the most common form of emergency dialysis worldwide. However, many aspects of this therapy are not standardized, and this therapy is also prone to treatment error, remains very costly, and is resource intensive. Despite these challenges, we know of no specific studies or programs of work that have tried to harmonize this practice variation by identifying "quality measures" for CRRT care. We believe this is a critically important knowledge gap for this core life support technology.
This work addressed this knowledge gap in three phases:
First, we reviewed the current state of evidence for quality and safety within critical care nephrology. While there have been advances in better defining AKI, the quality of care received by patients either at risk of or who have developed AKI remains suboptimal and no evidence-informed quality indicators (QIs) for CRRT care have not been rigorously evaluated.
This led to the second phase of work, which consisted of a systematic review to identify existing QIs for CRRT care. We identified 18 potential QIs. However, these QIs where characterized by heterogeneous definitions, varying quality of derivation and limited evaluation.
This informed the third phase of our research program, which was to develop a prioritized list of the most important of these QIs.
A modified Delphi process was conducted and arrived at a prioritized list of 13 QIs relating to CRRT structure (filter life and specialized care team),processes (delivered dose, downtime, fluid management, medication adjustment, time from prescription to therapy, therapy prescription and small solute clearance) and outcomes (adverse events, bleeding, catheter dysfunction, catheter line-associated bloodstream infections).
While consensus existed on the importance of these 13 QIs, future work will be required to better define the QIs, to establish benchmarks for bedside care and to operationalize these QIs into our healthcare data management systems. This will in turn create a CRRT Quality Dashboard that may be used to ensure the safe and high quality delivery of CRRT care to critically ill patients.