Acute Kidney Injury Standardized Clinical Assessment and Management Plan for Renal Replacement Initiation
| Status: | Recruiting |
|---|---|
| Conditions: | Renal Impairment / Chronic Kidney Disease, Hospital |
| Therapuetic Areas: | Nephrology / Urology, Other |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 1/17/2019 |
| Start Date: | July 1, 2017 |
| End Date: | December 2, 2019 |
This study is of a clinical decision support tool for clinicians taking care of patients with
severe acute kidney injury in the intensive care unit. Nephrologists will be given a
standardized clinical assessment and management plan (SCAMP), which is a tool to assist
clinicians in decision making on the need for renal replacement therapy (Mendu et al., CJASN
2017). In alternating months, nephrologists will be given the SCAMP vs. another simplified
form. The goal is to test whether patients whose clinicians are asked to fill out the SCAMP
have improved outcomes compared to the control group. The investigators are also collecting
information about provider adherence to the SCAMP and deviations from the SCAMP
recommendations to understand clinical decision making related to renal replacement.
severe acute kidney injury in the intensive care unit. Nephrologists will be given a
standardized clinical assessment and management plan (SCAMP), which is a tool to assist
clinicians in decision making on the need for renal replacement therapy (Mendu et al., CJASN
2017). In alternating months, nephrologists will be given the SCAMP vs. another simplified
form. The goal is to test whether patients whose clinicians are asked to fill out the SCAMP
have improved outcomes compared to the control group. The investigators are also collecting
information about provider adherence to the SCAMP and deviations from the SCAMP
recommendations to understand clinical decision making related to renal replacement.
Background: Acute Kidney Injury (AKI) is common among critically ill patients and is
associated with substantial morbidity and mortality. Severe AKI requiring renal replacement
therapy (RRT) is associated with in-hospital mortality rates exceeding 40%. The investigators
designed and implemented an AKI Standardized Clinical Assessment and Management Plan (SCAMP),
a decision-making algorithm to assist front-line nephrologists caring for patients with AKI.
The investigators piloted the implementation of the AKI SCAMP in the medical intensive care
unit at Brigham and Women's Hospital prospectively over the course of 1-year, and illustrated
that patients whose nephrologists adhered to the SCAMP recommendations had lower in-hospital
mortality. The investigators have a publication in press in the Clinical Journal of the
American Society of Nephrology detailing our findings (Mendu et al. CJASN January 2017).
Aims: The primary aim of this study is to expand the prospective implementation of the AKI
SCAMP to multiple intensive care units (ICUs) at Brigham and Women's Hospital in an
interrupted time series study (nephrologists will be asked to complete the AKI SCAMP
alternate months). The investigators aim to test the hypothesis generated by our pilot study,
that the utilization of an AKI SCAMP by providers in a critical care setting can reduce
in-hospital mortality. Expanding to multiple ICUs and introducing a time series design will
mitigate the limitations of our pilot data, such as a small sample size and confounding by
disease severity.
Design: The investigators seek to conduct a prospective interrupted time series study of the
implementation of an AKI SCAMP utilized by nephrologists in intensive care units during the
time period of 1 year to determine if utilization of the AKI SCAMP reduces in-hospital
mortality.
associated with substantial morbidity and mortality. Severe AKI requiring renal replacement
therapy (RRT) is associated with in-hospital mortality rates exceeding 40%. The investigators
designed and implemented an AKI Standardized Clinical Assessment and Management Plan (SCAMP),
a decision-making algorithm to assist front-line nephrologists caring for patients with AKI.
The investigators piloted the implementation of the AKI SCAMP in the medical intensive care
unit at Brigham and Women's Hospital prospectively over the course of 1-year, and illustrated
that patients whose nephrologists adhered to the SCAMP recommendations had lower in-hospital
mortality. The investigators have a publication in press in the Clinical Journal of the
American Society of Nephrology detailing our findings (Mendu et al. CJASN January 2017).
Aims: The primary aim of this study is to expand the prospective implementation of the AKI
SCAMP to multiple intensive care units (ICUs) at Brigham and Women's Hospital in an
interrupted time series study (nephrologists will be asked to complete the AKI SCAMP
alternate months). The investigators aim to test the hypothesis generated by our pilot study,
that the utilization of an AKI SCAMP by providers in a critical care setting can reduce
in-hospital mortality. Expanding to multiple ICUs and introducing a time series design will
mitigate the limitations of our pilot data, such as a small sample size and confounding by
disease severity.
Design: The investigators seek to conduct a prospective interrupted time series study of the
implementation of an AKI SCAMP utilized by nephrologists in intensive care units during the
time period of 1 year to determine if utilization of the AKI SCAMP reduces in-hospital
mortality.
Inclusion Criteria:
- Acute kidney injury, followed by nephrology consult service
- Intensive care unit
Exclusion Criteria:
- End stage renal disease
- Renal replacement therapy for advanced chronic kidney disease rather than acute kidney
injury.
We found this trial at
1
site
75 Francis street
Boston, Massachusetts 02115
Boston, Massachusetts 02115
(617) 732-5500
Phone: 203-809-9190
Brigham and Women's Hosp Boston’s Brigham and Women’s Hospital (BWH) is an international leader in...
Click here to add this to my saved trials
