Abstract: PUB211
Kidney Evaluation in Pediatric Cardiac Transplant Candidates: A Quality Improvement Initiative
Session Information
Category: Pediatric Nephrology
- 1800 Pediatric Nephrology
Authors
- Villanueva, Denise Nicole De Leon, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, United States
- Deraffele, Jacqueline, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, United States
- Richmond, Marc, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States
- Lattanza, Brittany, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States
- Kavanagh, Catherine R., Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States
Background
Acute kidney injury is common after pediatric cardiac transplant and has been linked to greater overall morbidity and mortality, including long-term chronic kidney disease risk. The purpose of this initiative was to standardize and increase renal evaluation during pre-transplant workup for pediatric cardiac transplant candidates to support early detection of kidney dysfunction and optimize overall post-transplant outcomes.
Methods
We aimed to increase nephrology assessment during pre-cardiac transplant evaluation from a baseline monthly median of 33% to at least 50%, and apply a standardized renal evaluation protocol to all candidates assessed by nephrology. Interventions included developing a renal evaluation protocol, obtaining nephrology and cardiology provider input, and requiring renal evaluation before cardiac transplant activation. We also created an EMR note template to improve protocol adherence and facilitate completion of evaluations by nephrology providers. Nephrology involvement and evaluations were compared pre- and post- intervention.
Results
Median monthly renal evaluations increased from 33% pre-intervention to 100% post-intervention, with all months exceeding the 50% goal (Figure 1). Among candidates who received renal evaluation, renal follow-up planning improved from 17% to 94%. Renal workup interpretation was documented in 100% of pre-intervention evaluations and 94% of post-intervention evaluations. Nephrology clearance for cardiac transplant was documented in 100% of evaluations in both periods. For inpatient evaluations, median time from initial visit to final recommendations improved from 5 days to 1 day.
Conclusion
A multidisciplinary initiative using a standardized renal evaluation protocol, EMR template, and revised pre-transplant workflow improved implementation of renal evaluation as part of the pre-cardiac transplant workup. This may help support better overall clinical outcomes in this high-risk population.
Figure 1. Run Chart