A four-cycle PDSA quality improvement initiative in pediatric CRRT patients significantly increased protein goal attainment (≥2.5 g/kg/day) from 27% at baseline to 83% (p=0.006).
Does a structured multidisciplinary quality improvement initiative improve protein delivery in pediatric CRRT patients?
A structured multidisciplinary quality improvement initiative significantly and sustainably improved protein goal attainment in pediatric CRRT patients.
Absolute Event Rate: 83% vs 27%
p-value: p=0.006
Introduction: Protein-energy wasting affects 31–40% of pediatric CRRT patients, increasing morbidity and mortality. At our institution, only 27% met protein goals (≥2.5 g/kg/day) by CRRT day 5. Prior PDSA cycles (1–3; n=49) incorporating a multidisciplinary team (intensivists, nephrologists, dietitians, pharmacists) improved delivery through EHR templates (PDSA1), education (PDSA2), and thrice-weekly bedside audits (PDSA3). Methods: From 2019–2024, we implemented PDSA4, a sustainability phase involving monthly benchmarking with leadership review (n=296). Outcomes (mean protein delivery, goal attainment, severe deficits) were compared to prior PDSA cycles. Results: Protein delivery improved from 1.79±0.93 g/kg/day (PDSA1) to 2.47±0.94 (PDSA4), a 38% increase. The largest gain occurred in PDSA3 (2.97±0.71), a 66% increase over baseline (p=0.024), with 85.7% achieving protein goals. Although PDSA4’s broader inclusion reduced mean intake (2.47 vs. 2.97, p=0.358), the most recent 100 patients maintained an 83% goal achievement rate, confirming sustainability. Severe protein deficits (< 1.5 g/kg/day) decreased from 36% to 7%. The overall improvement was statistically significant (Kruskal-Wallis χ2=12.29, p=0.006). Conclusions: Real-time audits (PDSA3) closed knowledge-to-practice gaps, while leadership benchmarking (PDSA4) sustained gains through accountability. The non-significant difference between PDSA3 and PDSA4 (p=0.358) suggests a performance plateau, with PDSA4 successfully scaling improvements to a larger cohort. This QI initiative elevated protein goal attainment from 27% to 83%, informing two system-level changes: embedded EHR protein recommendations and a standardized nutrition rounding checklist. Our experience demonstrates that structured, multidisciplinary QI initiatives can overcome barriers to optimal nutrition delivery in pediatric CRRT, offering a replicable, scalable, and sustainable model for other high-risk populations.
Vega et al. (Sun,) conducted a other in Pediatric continuous renal replacement therapy (CRRT) (n=345). Four-cycle PDSA quality initiative (EHR templates, education, audits, benchmarking) vs. Baseline/Prior PDSA cycles was evaluated on Protein goal attainment (≥2.5 g/kg/day) (p=0.006). A four-cycle PDSA quality improvement initiative in pediatric CRRT patients significantly increased protein goal attainment (≥2.5 g/kg/day) from 27% at baseline to 83% (p=0.006).