Development of key performance indicators for renal replacement therapy in adult intensive care to guide safe and cost-effective therapy

Introduction

Renal replacement therapy (RRT) is common. We undertook to develop and report some key performance indicators (KPIs) to monitor our provision of this costly therapy. We utilised data already collected in an electronic clinical information system that records the care received by our patients. We reduced our prescribed RRT dose to 25 ml/kg/hour in December 2011 following an appraisal of the literature [1]. We assessed whether the KPIs informed us if our practice changed and such changes were sustained.

Methods

We calculate the hourly effluent rate corrected for a patient's predicted body weight, and the lifespan of haemofilters. This takes less than 30 minutes each month. Statistical process control charts (SPCs) are used to assimilate the indicators over time.

Results

A total of 736 patients received RRT during the study. Prior to the dose change, the mean set and delivered doses were 39 and 31 ml/ kg/hour respectively. Thereafter the mean set and delivered doses were 33 and 26 ml/kg/hour respectively. Whilst higher than our guideline dose, they are significantly less than the doses prior to the change in practice (both P < 0.001). The SPC indicates that the change in practice has been sustained. See Figure 1 and Table 1.

Figure 1

Delivered dose of RRT each month.

Table 1 KPI for renal replacement therapy 2013

Conclusion

The KPIs could be produced quickly and allowed monitoring of the reduction in RRT dosing, assuring us that it is in excess of 20 ml/ kg/hour. The KPIs did not require additional data collection processes. We are developing similar indicators for other organ systems, therapies and processes.