CRRT Project

The project will track CRRT (HSC ICU only for now) (wikipedia-Hemofiltration Continuous Renal Replacement Therapy) use and reasons.

Purposes

• To identify the reason(s) why CRRT therapy was requested by the attending nephrologist for quality improvement and resource utilization in the Renal Program.
• To track the CRRT usage for workload and resource utilization in the Critical Care Program.

Data Collection Instructions

for which patients to code

HSC Critical Care patients only who get CRRT therapy.

how to code in CCMDB TMP

Nephrology will complete a the non-permanent health record form Renal Diagnostic Codes Checklist. This form is attached to a consult form in the HSC_ICUs and will stay on the patient chart. The Nephrology attending must enter the reason for CRRT in the form. Collectors simply transcribe this; no interpretation or correction against chart are required.

Enter

• Project: CRRT
• Item: enter the field checked in the form
  • there could be more than than one reason for CRRT, if so, enter 2 rows

Start and Stop Dates

• Start Date from CCMDB TMP: Monday Sept 19, 2016
  • CRRT usage from TISS only: January 1, 2016
• Evaluation Date: Jan 12.2017
• End date: none

Form revision start date=

• Oct 24, 2016 - HSC_ICU consultform will have a sticker pre-attached by unit clerk with list of Reasons for CRRT.

Background

The patients on CRRT therapy during the stay in ICU are being tracked by a CRN in Critical Care Program since ?? (date to be asked). The CRN collects the patient names, the hospital number, the renal diagnosis for reason for CRRT, the initiation and duration of therapy in paper form. The Renal Program states that they need the demographics of patients who were on CRRT as well as the reasons why CRRT were requested by Neprologists for quality improvement, resource utilization and billing purposes. Critical Care Program shares these information to the Renal Program by faxing the hand written data sheets to them on a monthly basis.

In Jan 2013, the Critical Care Program implemented the usage of the new TISS28 form which include various nursing activities, interventions and procedures including CRRT. The bed side nurse records on the TISS form these activities if present on a daily basis for each patient during the whole duration of stay at ICU. The data collectors of the Critical Care Database quality check the entries of the TISS forms for completion and consistencies. Since the same information is being collected by the CRN and bed side nurses, a comparative analysis between the two process of data collections and an additional real time audit by an independent auditor were done. TISS CRRT had 96% matched with the real time CRRT while 85% matched with the CRN CRRT.

The Critical Care and Renal Programs made a decision last Feb 2, 2016 to consider the TISS28 as the source of CRRT data starting Jan 2016.

However TISS28 does not contain the diagnostic reasons for CRRT therapy so a request to collect this information separately by the data collectors of the Critical Care Database was made. The Renal Program had identified the possible reasons for CRRT therapy and proposed to list them in a form for the attending Nephrologist to mark. The form has been developed and in Sept 2016 has been placed together with the Nephrologist's consult for the attending Nephrologist to fill up. A meeting has been held Sept 15, 2016 with the Critical Care Manager and Statistician to begin the collection of the CRRT diagnostic reasons in the next three months Oct to Dec 2016 and the group have agreed to have the results presented on Jan 12, 2017.

Template:CCMDB Data Integrity Checks

None yet

Additional data

There was not space in the tmp dropdown for the full length reason as on the form, so we use a shortened version in s_tmp table. To translate the shortened version to the full version, e.g. for reporting, use table s_tmp_CRRT.

SAS Program

• CRRT Days from TISS28 - The SAS program is in X:\Julie\CC Projects\CRRT_Ryan&Bueti\ICU_CRRT_byMonth.sas. The program generates the list of patient names, PHIN, Chart#, Date of Birth, First day on CRRT, year, month and calendar days on CRRT and total CRRT days.
• Reasons for CRRT - will be added to the SAS program above.

Discussion

• If possible, for STB, it would be optimal if the sheet that the renal attending could be put on the electronic chart. It could pop up when the orders are written for CRRT or the doctors could put it into their electronic progress notes. We may find that compliance using a paper sheet may not be good here. --LKolesar 10:48, 2016 February 9 (CST)
  • The CRRT project is piloted at HSC for now. There is no discussion yet if to be done at STB. JMojica 14:34, 2016 September 16 (CDT)

Requestor

• Critical Care Program: Jodi Walker Tweed, Ryan Holland
• Renal Program: Dr. Joe Bueti, Dr Herman Lam