Abstract
BackgroundRenal replacement therapy is increasingly utilized in the intensive care unit (ICU), of which continuous renal replacement therapy (CRRT) is most common. Despite CRRT being a relatively resource-intensive and expensive technology, there remains wide practice variation in its application. This systematic review will appraise the evidence for quality indicators (QIs) of CRRT care in critically ill patients.MethodsOvid MEDLINE, Ovid EMBASE, CINAHL, and the Cochrane Library including the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials (CENTRAL), and databases from the National Information Center of Health Services Research and Health Care Technology will be searched for original studies involving QIs in CRRT. Gray literature sources will be searched for technical reports, practice guidelines, and conference proceedings. Websites of relevant organizations will be identified, and industry leaders in the development and marketing of CRRT technology and non-profit organizations that represent key opinion leads in the use of CRRT will be contacted. We will search the Agency of Healthcare Research and Quality National Quality Measures Clearinghouse for CRRT-related QIs. Studies will be included if they contain quality measures, occur in critically ill patients, and are associated with CRRT. Analysis will be primarily descriptive. Each QI will be evaluated for importance, scientific acceptability, usability, and feasibility using the four criteria proposed by the United States Strategic Framework Board for a National Quality Measurement and Reporting System. Finally, QIs will be appraised for their potential operational characteristics, for their potential to be integrated into electronic medical records, and on their affordability, if applicable.DiscussionThis systematic review will comprehensively identify and synthesize QIs in CRRT. The results of this study will fuel the development of an inventory of essential QIs to support the appropriate, safe, and efficient delivery of CRRT in critically ill patients.Systematic review registrationPROSPERO CRD42015015530.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0088-1) contains supplementary material, which is available to authorized users.
Highlights
Renal replacement therapy is increasingly utilized in the intensive care unit (ICU), of which continuous renal replacement therapy (CRRT) is most common
Population-based estimates have suggested the incidence of acute RRT has increased by greater than 10 % per year over the past decade and continuous renal replacement therapy (CRRT) remains the most common form of RRT used in intensive care unit (ICU) settings [6,7,8]
Inclusion criteria Studies will be included if they mention all of the following themes: (1) quality measure, i.e., intended to evaluate the care received by patients treated with CRRT; (2) intensive care, i.e., intended to refer to patients supported in an intensive care unit setting; (3) continuous renal replacement therapy, i.e., the prescription, delivery, or outcome associated with CRRT; (4) language of study being English, French, German, Italian, or Spanish; (5) publication after
Summary
Study design We will perform a systematic review to identify and evaluate QIs for the prescription, delivery, and monitoring and their association with patient-centered and health economic outcomes (if available) for critically ill patients receiving CRRT using the guidelines from Cochrane and Center for Reviews and Dissemination and described according to the PRISMA-P guideline (Additional file 1) [20,21,22]. Due to the anticipated heterogeneity of QIs and methods of ascertainment, a comprehensive inventory of QIs will be developed and summarized as counts and proportions These summary counts and proportions will be further stratified based on relevant features such as study design, domains of health care quality, rank, and domains of evidence and evaluated using chi-square tests. All analyses will be performed using STATA statistical software, version 13 (StataCorp, College Station, Texas)
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