1. What is the decision or change (e.g., clinical topic, practice guideline, system design, delivery of care) you are facing or struggling with where a summary of the evidence would be helpful?
The issue I am struggling with is the outdated approach to diagnosing AKI. Conventional diagnostic protocols require Serum Creatinine analysis over 2-7 days by which time AKI damage has already occurred. Severity and prognosis are directly correlated to length of time before treatment. In order to test a novel alternative approach, continuous, digital urine output UO) and Intra Abdominal Pressure (IAP) measurements q.15 from 50,000 patient encounters were subjected to AI analysis. The result was an algorithm, validated by the FDA and awarded its BreakThrough Technology Award, which is capable of forecasting AKI 24 hours in advance of onset. i.e. 3-8 days faster than the standard method. The 24 hour warning allows therapeutic prevention of most but not all, AKI. AKI is a global healthcare problem affecting 26% of hospital admissions, 20-30% of CV surgical patients, 20-50% of ICU & PICU patients, 80% of the severely burned and carries an 18% mortality risk at 30 days. BUT importantly MOST AKI CAUSES ARE PREVENTABLE which is why I am struggling with this issue. Assuming the above statistics to be factual, it is difficult to accept that 'modern' critical care facilities can ethically claim to be State-of-the-Art unless they are able to determine a patient's UO or IAP in real-time? An evidence based EHC Program efficacy report should cause hospital administrators and employees of critical care facilities to answer that question and respond appropriately.
2. Why are you struggling with this issue?
Most physician and RN are unaware of the AKI diagnostic alternative feel resigned to treating, not preventing AKI. They are unaware that digital UO relieves RN's from manual hourly UO duty of that audible alarms can trigger when KIDGO UO flow limits <0.5mL/kG/H are breached. Many questions its claims and ask to perform their own 'mini clinical test' before committing. That simply is not impractical would delay benefits. Many financially constrained budget committees were badly burned by Bard's CritCore or Becton Dickinson's Sensica UO monitors or by IAP monitors offered by BD Bard, Sentinel or Inspire and simply are reluctant to purchase from an unknown, start-up touting a novel technology which is not yet required no regulated by The Joint Commission, AHRQ eCQMs or CMS's CoP and CfC. The few facilities still relying on single use intra-operative IAP find it costly, non-continuous and do not rely on it for AKI diagnosis. Thus, for a number of reasons, it remains unclear how to win over the numerous skeptics who look at the novel technology.
3. What do you want to see changed? How will you know that your issue is improving or has been addressed?
AHRQ has focused healthcare attention on reporting the incidence of Hospital Harm AKI, eCQM effective Oct. 2024. That requirement will prove a useful indicator of the effectiveness of the novel alternative AKI diagnostic approach. The pieces are now in place. It is up to hospitals and critical care facilities to do their parts by updating their care giving technology. An evidenced based EHC report could be helpful to incentivize adoption of State-the-Art technology. Hopefully, the Joint Commission would expeditiously follow suit and requirement its availability as prerequisite for hospital reaccreditation. A new Standard-of-Care is being upon us and without it, it will be increasingly difficult for any hospital or critical care facility to ethically claim it is providing State-of-the-Art care without exposing itself to legal repercussions. I look forward to the day CMS codifies these standards in CoPs and CfCs.
4. When do you need the evidence report?
Mon, 06/03/2024
5. What will you do with the evidence report?
I plan to use an edifying EHC evidence based consensus to ignite a renaissance of hope in AKI diagnosis and preventative care which will in turn offer relief to financially struggling hospital budgets and allow CMS to annually repurpose billions of dollars to other budget items. I believe this technology will avert potential suffering by numerous unsuspecting patients. Hospitalists, cardiac surgeons burn unit and trauma center staff are in desperate need of this technology. This novel technology was introduced in Jan 2018 but for numerous reasons including Covid, as of Jan 2024, a mere 68 of the more than 4,000 CMS approved hospitals had adopted. By each of us doing our part, I can only hope that I will be able to use an EHC evidence based report to positively effect the trajectory of hospital adoption for the benefit of all. I plan to share it with unconvinced physicians and hesitant hospital budget committees.
Optional Information About You
What is your role or perspective? Physician
May we contact you if we have questions about your nomination? Yes
