kaimrc 2014 oral presentation: are pathways effective in acute kidney injury
DESCRIPTION
First Prize Oral Presentation at the 2014 KAIMRC Scientific Forum, KSAU-HS Convention Center, Jeddah Saudi Arabia, September 10, 2014.TRANSCRIPT
Dr. Akram Ahmad | Medical Resident, R3Department of Internal Medicine – WRKing Abdulaziz Medical City – National Guard Health Affairs
Are Pathways Effective in Acute Kidney Injury (AKI)? A CHAMP-Path Pragmatic RCT
September 10, 2014KSAU-HS Convention Center, Jeddah
Grant-Recipient of KAIMRC (RC10/134 J); ClinicalTrials.gov NCT01561885
What is CHAMP-Path?
Patient
Physician
Nurse
Social Worker
Patient Educator
Clinical Nutritionist
Pharmacist
Grant-Recipient of KAIMRC (RC10/134 J); ClinicalTrials.gov NCT01561885
What is a Clinical Pathway?
PatientAdmission
Discharge
Day 1 Day 2 Day 3 Day 4 Day 5
Doctor
Nurse
Pharmacist
Social Worker
Patient Educator
Nutritionist
Plan of Care
Previous Studies
The Cochrane Library 2010, Issue 7
PragmaticRCT
Study Design
Parallel SingleBlind
1 Chertow et al. J Am Soc Nephrol 16: 3365-3370, 2005
Pathway Care is different from Usual Care interms of length of stay for Acute Kidney Injury.
Alternate
Hypothesis
Sample Size Calculation
Size Power Alpha LOS1 Reduction in
LOS (days)
38 patients 80% 5% 5 ±1.8 2
LOS
Decreaseby 2 days
Chertow et al. J Am Soc Nephrol 16: 3365-3370, 2005
Primary Objective
Pathway Carevs.
Usual Care
In-hospital Mortality 30-Day Readmission
Determinants of LOS Patient Centeredness
Secondary Objectives
On-call Medical Residents Eligibility Criteria
Written Informed Consent
Patient Randomization &
Allocation
Usual Careor
Pathway Care*
Admission CTU 1 orCTU 2*
Usual Process or
Pathway Referral*
Multidisciplinary Healthcare Team
Notified*
Pathway Care Applied*
Methods
(*) Pathway Care
Eligibility Criteria
1
1 AKIN Criteria, Critical Care. 2007; 11(2):R31
1
Baseline Characteristics
Intention to Treat Analysis
4.96
4.80
4 4.2 4.4 4.6 4.8 5
Median LOS (days)
Usual (n=20) Pathway (n=18)
(p= 0.77)
Per Protocol Analysis
3.12
4.63
0 1 2 3 4 5
Median LOS (days)
Usual (n=17) Pathway (n=12)
(p= 0.18)
Secondary Outcomes
0 Patients
In-hospital Mortality
30-Day Readmission
LOS
Improved CreatinineLevels
Ultrasound
Determinants of LOS
Predictive
Creatinine (p= 0.39)
Ultrasound (p= 0.54)
134140
0
20
40
60
80
100
120
140
160
180
200M
ean
Sco
re
Care Type
Patient Satisfaction with CareUsual (n=12) Pathway (n=11)
(p= 0.502)
Are Pathways Effective in
Acute Kidney Injury?
Conclusions
Pathway Care
Usual Care
ClinicalEffectivenessSuggestive
CHAMP-Path Ongoing
Trials
Per Protocol Analysis
Pitfalls
Pathway Care
Usual Care
Contamination
Pat
hw
ay O
utc
om
es
Pathway Adherence
Hospital-acquired
Critically-ill
Community-acquired
Supportive Care
Coauthors
Dr. Salhah AlSulami Dr. Raad AlWithenani Dr. Osamah HakamiDr. Thamer AlAifan Dr. Abdullah AlMalki Dr. Saliman KarsouDr. Zuhair Abunijem Dr. Mohammad Qureshi Dr. Mohammad BallaDr. Rehan Qureshi Dr. AbdulHameed Gasim Dr. Zeyad ZahraniDr. K.H.Mujtaba Quadri
Ms. Jani Hafez Dr. Sherine Ismail Ms. Jane Thomson
Ms. Doha AlMadani Dr. Oyindamola YusufDr. Muhammad Amir Siddiqui Ms. Maryam Khalil
Medicine
Quality Management Pharmacy Nursing
KAIMRC-Jeddah
AcknowledgementsAll Medical Residents, General Internal Medicine CTU Consultants, Nursing Department, Pharmaceutical Care Department, Quality Management, Health Promotions Department, Clinical Nutrition Department, Medical Ward Unit Assistants, Medical Records Department, KAIMRC, and Department of Medicine