A Mixed-Methods Assessment of Health Care Professionals’ Perspectives on CRRT Delivery and Opportunities for Improvement
7 affiliations
- 1Division of Nephrology, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL
- 2Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL
- 3Division of General Internal Medicine & Population Science, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL
- 4Division of Nephrology, Centre Hospitalier de university de Montréal, Montreal, QC, Canada
- 5Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
- 6Department of Medicine, Queen’s University, Kingston, ON, Canada
- 7Division of Nephrology and Hypertension, University of California San Diego, San Diego, CA
Abstract
Rationale & Objective: 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 gaps in CRRT practice and explore strategies to improve CRRT delivery from the perspective of multidisciplinary health care professionals. Study Design: Convergent parallel mixed methods. Setting & Participants: This study was conducted during the 2024 CRRT Academy and included multidisciplinary participants comprising trainees (residents and fellows), clinicians (nephrologists and intensivists), clinical staff (nurses, nurse practitioners, and pharmacists), and industry/research affiliates. Analytical Approach: Quantitative data were collected using a survey assessing CRRT practices, standardization, and collection of quality metrics. Qualitative data were obtained through 5 semistructured focus group discussions (4 with participants and 1 with CRRT Academy faculty) and were analyzed using a combined inductive-deductive thematic approach in NVivo 15. Results: There were 83 participants: 54 trainees, 19 clinicians, 8 clinical staff, and 2 industry/research affiliates, with 10-24 participants in each focus group. The following 4 key themes were identified as relevant to improve CRRT delivery from participant focus groups: (1) teamwork and multidisciplinary communication, (2) collection and tracking of CRRT-relevant metrics, (3) protocol standardization while allowing flexibility to individualize care, and (4) education for clinicians and clinical staff. The faculty focus group emphasized the need for institutional financial support and leadership-driven quality improvement (QI) initiatives, highlighting the importance of nephrologist advocacy. Participants reported significant variability in CRRT processes, QI data collection, and education across institutions, with limited adoption of CRRT key performance indicators owing to lack of consensus and workflow integration challenges. Limitations: Participants primarily represented academic centers and the majority were trainees, which may limit generalizability of the findings. However, given the paucity of mixed-methods evidence about current CRRT practice, this study provides novel insights that can help advance standardization. Conclusions: This 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. Plain-Language Summary: Continuous renal replacement therapy (CRRT) is a life-saving form of dialysis used in critically ill patients, but how it is delivered varies widely across hospitals. We conducted this study to better understand current practices and identify opportunities for improvement from the perspective of health care professionals. Using surveys and group discussions with clinicians, trainees, nurses, and other stakeholders, we found important gaps in interprofessional teamwork, data monitoring, CRRT standardization, and training. Many centers do not routinely monitor key aspects of CRRT, and approaches to care differ significantly even among academic hospitals. These findings highlight the need for better communication, more consistent protocols, and improved education and data systems. Addressing these areas may help improve the quality and outcomes of CRRT care.
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BibTeX
@article{rehman2026mixedmethods,
title = {{A Mixed-Methods Assessment of Health Care Professionals’ Perspectives on CRRT Delivery and Opportunities for Improvement}},
author = {Aqeeb Ur Rehman and Heather Lee and Lori B. Bateman and William Beaubien-Souligny and Oleksa Rewa and Samuel A. Silver and Ashita J. Tolwani and Pranav S. Garimella and Javier A. Neyra},
journal = {Kidney Medicine},
year = {2026},
month = sep,
doi = {10.1016/j.xkme.2026.101531},
url = {https://doi.org/10.1016/j.xkme.2026.101531},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - A Mixed-Methods Assessment of Health Care Professionals’ Perspectives on CRRT Delivery and Opportunities for Improvement
AU - Aqeeb Ur Rehman
AU - Heather Lee
AU - Lori B. Bateman
AU - William Beaubien-Souligny
AU - Oleksa Rewa
AU - Samuel A. Silver
AU - Ashita J. Tolwani
AU - Pranav S. Garimella
AU - Javier A. Neyra
PY - 2026
DA - 2026/09/12
JO - Kidney Medicine
DO - 10.1016/j.xkme.2026.101531
UR - https://doi.org/10.1016/j.xkme.2026.101531
AB - Rationale & Objective: 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 gaps in CRRT practice and explore strategies to improve CRRT delivery from the perspective of multidisciplinary health care professionals. Study Design: Convergent parallel mixed methods. Setting & Participants: This study was conducted during the 2024 CRRT Academy and included multidisciplinary participants comprising trainees (residents and fellows), clinicians (nephrologists and intensivists), clinical staff (nurses, nurse practitioners, and pharmacists), and industry/research affiliates. Analytical Approach: Quantitative data were collected using a survey assessing CRRT practices, standardization, and collection of quality metrics. Qualitative data were obtained through 5 semistructured focus group discussions (4 with participants and 1 with CRRT Academy faculty) and were analyzed using a combined inductive-deductive thematic approach in NVivo 15. Results: There were 83 participants: 54 trainees, 19 clinicians, 8 clinical staff, and 2 industry/research affiliates, with 10-24 participants in each focus group. The following 4 key themes were identified as relevant to improve CRRT delivery from participant focus groups: (1) teamwork and multidisciplinary communication, (2) collection and tracking of CRRT-relevant metrics, (3) protocol standardization while allowing flexibility to individualize care, and (4) education for clinicians and clinical staff. The faculty focus group emphasized the need for institutional financial support and leadership-driven quality improvement (QI) initiatives, highlighting the importance of nephrologist advocacy. Participants reported significant variability in CRRT processes, QI data collection, and education across institutions, with limited adoption of CRRT key performance indicators owing to lack of consensus and workflow integration challenges. Limitations: Participants primarily represented academic centers and the majority were trainees, which may limit generalizability of the findings. However, given the paucity of mixed-methods evidence about current CRRT practice, this study provides novel insights that can help advance standardization. Conclusions: This 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. Plain-Language Summary: Continuous renal replacement therapy (CRRT) is a life-saving form of dialysis used in critically ill patients, but how it is delivered varies widely across hospitals. We conducted this study to better understand current practices and identify opportunities for improvement from the perspective of health care professionals. Using surveys and group discussions with clinicians, trainees, nurses, and other stakeholders, we found important gaps in interprofessional teamwork, data monitoring, CRRT standardization, and training. Many centers do not routinely monitor key aspects of CRRT, and approaches to care differ significantly even among academic hospitals. These findings highlight the need for better communication, more consistent protocols, and improved education and data systems. Addressing these areas may help improve the quality and outcomes of CRRT care.
SN - 2590-0595
ER -