TY - JOUR
T1 - Impact of computerized order entry and pre-mixed dialysis solutions for continuous veno-venous hemodiafiltration on selection of therapy for acute renal failure
AU - Saadulla, Lawand
AU - Reeves, W. Brian
AU - Irey, Brittany
AU - Ghahramani, Nasrollah
N1 - Funding Information:
Acknowledgment Dr. Nasrollah Ghahramani was supported by the Penn State College of Medicine Physician Scientist Award. This publication was made possible by grant number D1BTH06321-01 from the Office for the Advancement of Telehealth, Health Resources and Services Administration, Department of Health and Human Services.
PY - 2012/2
Y1 - 2012/2
N2 - To investigate the impacts of availability of premixed solutions and computerized order entry on nephrologists' choice of the initial mode of renal replacement therapy in acute renal failure.We studied 898 patients with acute renal failure in 3 consecutive eras: era 1 (custom-mixed solution; n=309), era 2 (pre-mixed commercial solution; n=324), and era 3 (post-computerized order entry; n=265). The proportion of patients treated with renal replacement therapy and the time from consult to initiation of continuous renal replacement therapy was similar in the 3 eras. Following introduction of the pre-mixed solution, the proportion of patients treated with continuous renal replacement therapy increased (20% vs. 33%; p<0.05), it was initiated at a lower serum creatinine (353±123 μmol/L vs. 300±80 μmol/L; p<0.05) and in older patients (53±12 vs. 61±14 years; p<0.05). There was a progressive increase in the use of continuous veno-venous hemodialysis (18% vs. 79% vs. 100%; p<0.05) and in the total prescribed flow rate (1,382±546 vs. 2,324±737 vs. 2,900±305 mL/hr 3; p<0.05). There was no significant impact on mortality. The availability of a pre-mixed solution increases the likelihood of initiating continuous renal replacement therapy in acute renal failure, initiating it at a lower creatinine and for older patients, use of continuous veno-venous hemodialysis and higher prescribed continuous renal replacement therapy dose. Computerized order entry implementation is associated with an additional increase in the use of continuous veno-venous hemodialysis, higher total prescribed dialysis dose, and use of CRRT among an increasing number of patients not on mechanical ventilation. The effect of these changes on patient survival is not significant.
AB - To investigate the impacts of availability of premixed solutions and computerized order entry on nephrologists' choice of the initial mode of renal replacement therapy in acute renal failure.We studied 898 patients with acute renal failure in 3 consecutive eras: era 1 (custom-mixed solution; n=309), era 2 (pre-mixed commercial solution; n=324), and era 3 (post-computerized order entry; n=265). The proportion of patients treated with renal replacement therapy and the time from consult to initiation of continuous renal replacement therapy was similar in the 3 eras. Following introduction of the pre-mixed solution, the proportion of patients treated with continuous renal replacement therapy increased (20% vs. 33%; p<0.05), it was initiated at a lower serum creatinine (353±123 μmol/L vs. 300±80 μmol/L; p<0.05) and in older patients (53±12 vs. 61±14 years; p<0.05). There was a progressive increase in the use of continuous veno-venous hemodialysis (18% vs. 79% vs. 100%; p<0.05) and in the total prescribed flow rate (1,382±546 vs. 2,324±737 vs. 2,900±305 mL/hr 3; p<0.05). There was no significant impact on mortality. The availability of a pre-mixed solution increases the likelihood of initiating continuous renal replacement therapy in acute renal failure, initiating it at a lower creatinine and for older patients, use of continuous veno-venous hemodialysis and higher prescribed continuous renal replacement therapy dose. Computerized order entry implementation is associated with an additional increase in the use of continuous veno-venous hemodialysis, higher total prescribed dialysis dose, and use of CRRT among an increasing number of patients not on mechanical ventilation. The effect of these changes on patient survival is not significant.
KW - Acute renal failure
KW - CRRT
KW - Computerized order entry
KW - Hemodialysis
UR - http://www.scopus.com/inward/record.url?scp=84860233407&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84860233407&partnerID=8YFLogxK
U2 - 10.1007/s10916-010-9471-6
DO - 10.1007/s10916-010-9471-6
M3 - Article
C2 - 20703723
AN - SCOPUS:84860233407
SN - 0148-5598
VL - 36
SP - 223
EP - 231
JO - Journal of Medical Systems
JF - Journal of Medical Systems
IS - 1
ER -