Implementation of a Renal Failure Risk Assessment Tool Prior to Cardiothoracic Surgery: An Evidence-based Practice Project

Of patients undergoing cardiothoracic surgery (CTS), up to 50% are at risk of developing an acute kidney injury (AKI) after surgery (Zaouter et al., 2018). Acute kidney injury and renal failure can increase mortality and morbidity and lead to more extended hospital stays, longer ICU stays, and higher costs (Kajal et al., 2022). Pre-operative prediction tools are widely used in the medical field but are underutilized in predicting cardiothoracic surgery associated AKI (Guan et al., 2019). Local Problem: In 2022, an academic medical center in the United States performed 463 cardiothoracic surgery (CTS) cases, and 8.8% of patients suffered renal failure. The current practice at the medical center for screening patients for risk of renal failure before surgery is using a risk calculator provided by the Society of Thoracic Surgery (STS) but only for applicable surgeries. In 2022, 77% of patients with new-onset renal failure did not have a renal failure risk assessment before CTS. Methods: A validated renal failure risk assessment tool (Thakar score) was selected based on evidence-based research to fill the gap in the current practice. A documentation shortcut called a "dot phrase" was developed to add the calculated Thakar score to documentation. A summary page in the electronic health record (EHR) was developed to house the Thakar score to be used as a communication tool for providers in all phases of care. Interventions: Education was provided to advanced practice clinicians (APCs) about the Thakar score and dot phrase with two in-person education sessions. Open discussion and a post education survey were used to assess current practice and perceived barriers to using the Thakar score. After an implementation period of four weeks, feasibility, usability, and satisfaction were assessed using non-validated RedCap surveys. Results: During the four-week implementation period, the Thakar score was documented on 64 patients, representing 56% of total patients seen for an initial consultation. Change statistics could not be determined due to a lack of data with current practice. The majority of providers were satisfied with the tool and intended to continue to screen patients using the Thakar before CTS. Conclusion: The use of the Thakar score is a feasible solution to the screening gap for renal failure that is present in the patient population at this academic medical center. Future work needs to be done to determine the exact change statistics for screening rates and triage of patients who are found to be at high risk for renal failure before CTS.