How to Improve Your CRRT Program: A Qualitative Assessment of Health Care Professionals' Perspectives on CRRT Care
Bibliographic record
Abstract
Background: Continuous renal replacement therapy (CRRT) is the preferred dialysis modality for critically ill patients with acute kidney injury, yet its delivery and quality vary across institutions. This study aimed to identify current gaps in CRRT practice and explore strategies to improve programmatic CRRT delivery from the perspective of multidisciplinary healthcare professionals. Methods: A qualitative study was conducted during the 2024 University of Alabama at Birmingham (UAB) CRRT Academy using five focus group discussions. Participants included fellows in training, staff (nurses, nurse practitioners, pharmacists) and clinicians (nephrologists, intensivists) with varying CRRT experience. CRRT Academy faculty joined a separate focus group for comparison. Transcripts were analyzed using a combined inductive-deductive thematic approach in NVivo 15. Results: There were 81 participants: 54 fellows in training, 9 staff and 18 faculty. Four key themes were identified as relevant to improve CRRT delivery: 1) teamwork and multidisciplinary communication, 2) collection of CRRT performance and process metrics and development of quality improvement (QI) initiatives, 3) protocol standardization while allowing flexibility to individualize care, and 4) education for clinicians, pharmacists, and nurses. Faculty emphasized the need for monetary investment and support from administration and leadership of QI initiatives, noting nephrologists must advocate more proactively for improvement in CRRT care. Participants reported significant variability in CRRT prescription, data collection, and training across institutions. Most participants cited limited adoption of CRRT performance/process indicators due to lack of consensus on definitions and difficulty accessing or integrating these metrics into clinical workflows. Conclusion: This qualitative study underscores key areas for improving CRRT delivery, including interprofessional collaboration, data-driven QI, protocol standardization, and targeted education. Addressing these themes may help improve CRRT processes of care and patient-centered outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.034 | 0.038 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.011 | 0.010 |
| Scholarly communication | 0.005 | 0.004 |
| Open science | 0.002 | 0.008 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".