| Description |
Background: Continuous Renal Replacement Therapy (CRRT) is increasingly essential for supporting critically ill neonates, particularly those with acute kidney injury (AKI), fluid overload, sepsis, or metabolic disorders. Advances in CRRT technology, such as dedicated neonatal machines, have improved safety and efficacy, especially in those weighing less than 3 kilograms. Despite these advancements, challenges remain in initiating a neonatal CRRT program stemming from education gaps and staffing constraints that impede consistent implementation and optimal outcomes. This project aimed to assess the need for a neonatalbased CRRT team. We aimed to (1) assess the current hospital wide CRRT program, (2) evaluate facilitators and barriers to CRRT use in the NICU, (3) create recommendations for a specialized CRRT program, and (4) evaluate the feasibility, usability, and satisfaction of the proposed program. Methods: This needs assessment project occurred in a 51-bed, all-referral Level IV NICU in the urban Intermountain West. The project involved a comprehensive SWOT analysis, which included surveying current hospital staff, a retrospective chart review, meeting with stakeholders to identify program needs, and benchmarking against other neonatal CRRT programs. Interventions: Hospital staff completed 20-question surveys, which included demographics, Likert-based questions, and open-ended questions about their training and experiences with CRRT and neonatal care. We met with stakeholders and other hospitals to understand the current program and barriers to change. Benchmarking interviews were recorded and assessed for similarities and differences between programs. Results: Out of 118 completed surveys, (55.5%, n=59) of respondents reported having CRRT training. Key barriers identified included the need for additional training (85%, n=35), staffing difficulties (70%, n=29), and lack of education (65%, n=27). The SWOT analysis highlighted strengths such as existing CRRT protocols and dedicated staff, while weaknesses included limited resources and high turnover rates. The financial analysis shows the specialized CRRT program is viable, with a daily margin of $1656.76 in 2024. The NICU contributed 20% ($199,286.72) to the annual revenue of $604,717.40. For 2025, increased reimbursements and completed capital expenditures should enhance financial outcomes further. Benchmarking against other neonatal CRRT programs demonstrated the feasibility of a specialized team, with improved patient outcomes and satisfaction reported in centers with dedicated CRRT teams. Conclusion: The findings demonstrate the feasibility and benefits of developing a specialized CRRT program in the NICU to address the unique needs of critically ill neonates. Recommendations include targeted training for CRRT nurses and optimized staffing models excluding Clinical Support Leaders (CSLs) from staffing numbers to enhance patient safety and oversight during critical procedures. This initiative aligns with Intermountain Health's mission to provide high-quality, patient-centered care, supporting integrity, quality, and safety values. The next steps involve developing a detailed implementation plan, incorporating stakeholder feedback, and establishing ongoing evaluation and quality improvement initiatives. The potential for spreading this specialized CRRT program to other contexts is significant, promoting equitable health outcomes for critically ill neonates. |
