251 - Safety and Timeliness of Remote Initiation of Continuous Kidney Replacement Therapy using Telemedicine

Poster Number: 251
Publication Number: 251.25

Michelle C. Starr, Indiana University School of Medicine, Indinapolis, IN, United States; Kathleen Altemose, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Jessalynn Parsley, Riley Hospital for Children at IU Health, Indianapolis, IN, United States; Daniel T. Cater, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; David Hains, Indiana University School of Medicine, Indianapolis, IN, United States; Danielle Soranno, Indiana University, Indianapolis, IN, United States

Background:
Our acute dialysis program transitioned some continuous kidney replacement therapy (CKRT) initiations to telemedicine to improve timeliness and to minimize COVID-19 transmission risk. For CKRT initiations during nights or weekends, the decision to remote start is made by the nephrology and critical care physicians on a patient-by-patient basis. Using a secure video telemedicine platform, nephrology oversees the initiation process in collaboration with the in-person critical care team. 


Objective: While the introduction of telemedicine would appear appropriate and acceptable for many clinical settings, the safety and timeliness of remote initiation of CKRT has not been described.

Design/Methods: Retrospective analysis of a single-center process improvement project. Information on patient characteristics and CKRT therapy were extracted from the electronic health record. Provider attitudes were assessed using Likert scale survey.

Results:
Since January 2021, there have been 101 CKRT circuit initiations at our program in patients not previously receiving CKRT, with 33% (33/101) initiated remotely. Patient characteristics, including patient age, weight at initiation, underlying diagnosis, severity of illness, and degree of fluid overload did not differ between in-person CKRT initiation and remote initiation. Remote CKRT initiation was more common in the Cardiac ICU (p=0.002). CKRT prescription, including machine choice, modality and anticoagulation did not differ (Table 1).



 CKRT remote initiations were timelier, occurring on average 3.0 hours after decision to initiate therapy compared to 5.8 hours for all in-person CKRT starts (p< 0.001) and 5.5 hours for night and weekend starts (p< 0.001). Rate of cardiovascular complications at initiation did not differ between telemedicine and in-person starts (15%), and initial circuit life was similar between groups. There were no differences in likelihood of death or duration of CKRT therapy.



Remote initiations were widely acceptable to providers. Of 38 respondents to our survey (15 critical care physicians, 10 pediatric nephrologists and 13 CKRT nurses), remote starts were considered equally safe to in-person starts (4.4/5), nephrology was thought to be accessible during initiation (4.5/5) while improving workforce wellness and decreasing burnout (4.7/5).


Conclusion(s):
In appropriately selected patients, remote initiation of CKRT using telemedicine is a timely and safe option. Further standardization of remote initiation of CKRT should be considered in appropriate patients to improve the timely delivery of CKRT and may improve nephrology workforce wellness.