Program of quality improvement for extracorporeal blood purification therapies in the intensive care unit

Critically ill patients often require complex extracorporeal treatments, such as extracorporeal blood purification (EBP). At the bedside, there can be reluctance or uncertainty about when to initiate EBP, and there is no standard agreement on which goals to pursue, what prescriptions to use to achieve those goals, or which recommendations to follow to prevent complications. Furthermore, an accurate analysis of why clinical goals are not achieved or how often the patient should be reassessed to readjust the EBP prescription is not currently standardized. This narrative review describes the main actions characterizing a quality improvement program for EBP in the ICU, which took place at the University of Florence and was subsequently adopted at the national level. The pillars of this program were: (1) definition, implementation, and dissemination of information and communication technology tools aimed at objectively measuring results at the bedside, supporting dynamic prescribing and precision medicine, and promoting advances in knowledge in this field; (2) creation of a national multi-professional network of clinical users and researchers in EBP; (3) promotion and maintenance of technical and non-technical skills in EBP based on the reformulation of advanced academic training in this field.