Implementation of the VExUS Protocol: A Quality Improvement Project

Background: Renal disease remains a significant problem in the United States, where 37 million people live with chronic kidney disease (CKD) and 786,000 live with end-stage renal disease (ESRD). Accurate fluid status assessment is essential to caring for these patients. Local Problem: The University of Utah Hospital's inpatient nephrology service does not currently have a standard fluid status scoring system in place. The lack of a standard fluid status scoring system has been identified as a potential gap where a novel ultrasound-scoring tool, the VExUS protocol, could be used by providers to assess venous congestion objectively. Methods: A pre/post intervention design was used with a retrospective chart review prior to project implementation. The providers' charted and reported fluid status assessments were used to highlight the need for the VExUS protocol and increased driving forces to unfreeze current habits and utilize a standardized approach to assessment. Interventions: An educational and multimedia presentation was developed and presented to the providers. The presentation included how to perform the exam, with an opportunity for hands-on practice with an ultrasound machine and a live patient model. An in person question and answer period was offered. Post-implementation surveys were sent to the providers to determine the effectiveness of the education and the providers' engagement in using the VExUS protocol. Results: Pre-intervention consistent fluid status assessments were not found per the chart review. Pre- survey results demonstrated variable provider approaches to assessment. Post-intervention, the quality improvement project found that 100% of providers (N=7) either agreed that VExUS could be a feasible tool for assessing venous congestion and that they were satisfied with VExUS. All providers "Strongly agreed" that the presentation was clear. Conclusion: The implementation of the VExUS protocol appeared to be a feasible and well-regarded tool for providers in the nephrology department to assess for venous congestion. Replication of this quality improvement project is needed to determine if similar rates of success are found in other settings.