MedicalResearch.com Interview with:
Rodrigo F. Alban, MD FACS
Associate Director Performance Improvement
Associate Residency Program Director
NSQIP Surgeon Champion
Department of Surgery
Cedars-Sinai Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Continuous Renal Replacement Therapy (CRRT) is a modality of hemodialysis commonly used to manage renal failure in critically ill patients who have significant hemodynamic compromise. However, it is also resource-intensive and costly and its usage is highly variable and lacks standardization.
Our institution organized a multidisciplinary task force to target high value care in critically ill patients requiring CRRT by standardizing its process flow, promoting cross-disciplinary discussions with patients and family members, and increasing visibility/awareness of CRRT use. After our interventions, the mean duration of CRRT decreased by 11.3% from 7.43 to 6.59 days per patient. We also saw a 9.8% decrease in the mean direct cost of CRRT from $11642 to $10506 per patient. Finally, we also saw a decrease in the proportion of patients expiring on CRRT, and an increase in the proportion of patients transitioning to comfort care.
MedicalResearch.com: What should readers take away from your report?
Response: There are many strategies that we can use to target high value care. Resource utilization in the Intensive Care Unit is a prime target to address value-based care interventions. In our case, our experience with CRRT serves as an example of how physicians from multiple specialties can collaborate together and promote meaningful use of an essential, but costly treatment for renal failure.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: A prospective trial with a control group for comparison would better support a causal relationship between our interventions and our findings.
Tseng J, Halbert RJ, Minissian N, Rodriguez H, Barathan S, Hain P, Alban RF. Association of Standardization of Continuous Renal Replacement Therapy and High-Value Care
An Evidence-Based Approach. JAMA Intern Med. Published online February 26, 2018. doi:10.1001/jamainternmed.2017.8732
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