Improving the Comfort Level of Medical Intensive Care Unit (ICU) Advanced Practice Providers with Renal Replacement Therapy (RRT) Modalities

Background: Adult ICUs nationwide are estimated to have 51.6% staffed with physicians-in-training and 72.1% have nurse practitioners (NP) or physician assistants (PA). Aligning preferences and improving understanding amongst different RRT modalities can foster stronger team dynamics and effective collaboration. The objective of this study is to assess the level of comfort with MICU (medical ICU) providers regarding all types of RRT. Methods: A 30-minute lecture was led in person by a nephrology fellow and a nephology ICU attending. The target population included the MICU intensivists, mid-levels (including NPs, PA, Residents, and Fellows) and medical students. A Likert scale (pre- and post - survey) assessed comfort with: (1) types of RRT, (2) continuous RRT (CRRT), (3) use of ultrafiltration (UF) or sustained continuous UF (SCUF), (4) prolonged intermittent RRT (PIRRT), and (5) recognition of the RRT modality. Results: Pre-survey responses from midlevel providers (89%) and medical students (11%) were collected. 34% reported that they were not comfortable knowing all types of RRT. Most notably, 67% were not comfortable when UF or SCUF modalities were used. Only 11% reported that they were comfortable with the use of PIRRT. 45% were not comfortable with recognition of the type of RRT modality present. Post-survey responses revealed that all participants reported that they felt somewhat comfortable or comfortable with all various types of RRT. Conclusion: Although the majority reported some comfort with RRT, only a few were comfortable with UF, SCUF, and PIRRT modalities. These findings suggest that short, focused teaching can meaningfully improve ICU provider confidence and may reduce discordance with nephrology teams, ultimately fostering good team dynamics.Likert Scale Responses