• Theresa Mottes, Tonie Owens, Matthew Niedner, Julie Juno, Thomas P Shanley, and Michael Heung.
• 1Division of Nephrology, Department of Pediatrics & Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI. 2Division of Critical Care, Department of Pediatrics & Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI. 3Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
• Pediatr Crit Care Me. 2013 Oct 1;14(8):747-54.

PurposeTo describe our experience with transitions in both nursing model and educational training program for delivery of continuous renal replacement therapy. There have been very few comparisons between different care and educational models, and the optimal approach remains uncertain. In particular, we evaluated our experience with introducing a simulation-based educational model.DesignProspective quality control observational study.SettingThe ICU of a tertiary care pediatric referral center.PatientsAll patients undergoing CRRT between July 2007 through July 2010 were included.Measurements And Main ResultsWe monitored CRRT filter life during a transition from a collaborative to critical care nursing model, and subsequently during a transition from a didactic education program to simulation-based training. During the study period, 80 patients underwent continuous renal replacement therapy with use of 343 filters. Process control charts demonstrated a significant increase in filter life and a decrease in unplanned filter changes. Both of these signals emerged at the same time and corresponded with the introduction of the simulation-based education program. Further statistical analysis showed that filter life improved from 42.5 hours (18.2-66.4 hr) during the didactic education program to 59.4 hours (22.2-76.4 hr) during the simulation-based education program (p = 0.008). This relationship persisted when excluding nonpreventable premature filter discontinuations and in a multivariate model that accounted for other potential influences on filter life.ConclusionsWe report on the impact of transitioning between different educational programs for continuous renal replacement therapy, specifically with the introduction of a simulation-based approach. We observed a significant and sustained improvement in the delivery of continuous renal replacement therapy as demonstrated by a marked increase in filter lifespan.

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