J. Tseng1, P. Hain1, S. Barathan1, H. Rodriguez1, T. Griner1, M. S. Rambod1, N. Parrish1, H. Sax1, R. F. Alban1 1Cedars-Sinai Medical Center,Los Angeles, CA, USA
Introduction:
Continuous Renal Replacement Therapy (CRRT) is a dialysis modality that is essential in the management of critically ill patients with renal failure. It confers the advantage of removing solutes and fluid at a slow, constant rate, with lower rates of hypotension and other adverse events. CRRT use has increased over time, particularly in surgical patients. We sought to assess current utilization patterns of CRRT at our institution and to standardize usage and efficiency in a collaborative approach.
Methods:
Data was collected for fiscal years 2013 to 2016 at a large urban academic medical center. A task force was developed in October 2015 involving intensive care units (ICUs), nursing and nephrology leadership with an effort to apply standardized guidelines for initiation and termination of CRRT, improve daily communication and documentation between the Nephrology, ICU teams, and ICU nursing staff. In addition to other measures, electronic order sets were revised to reassess the need for CRRT and its associated labs on a daily basis. Utilization data and related costs were calculated using our internal data warehouse and finance department. Fiscal year (FY) data before and after the intervention were compared.
Results:
From 2013 to 2016, the total volume of patients on CRRT increased by 187% (233 to 435), and the total number of CRRT days increased by 191% (1,704 to 3,257) with the large majority of patients being surgical (62%). Prior to intervention, the median number of CRRT days per patient peaked at 8 days for FY2014 and FY2015. This decreased to 7 after our intervention for FY2016. The total direct cost of CRRT increased yearly from $2.84 million in 2013 to $4.37 million in FY2016, while the average cost of CRRT per patient decreased from $12,167 in FY2013 to $11,548 in FY2015, and further to $10,030 in FY2016. This resulted in savings per case of $1,518, to a total annualized saving of $660,220 for FY2016. In addition, case mix index increased yearly from 8.82 in FY2013 to 9.35 in FY2016.
Conclusion:
By establishing a task force to critically review the usage of CRRT and implementing best practice guidelines and collaboration policies, we significantly reduced the cost of CRRT per case across all ICUs at our institution. These resulted in significant cost savings and improved documentation.