Screen Reader Mode Icon Check SCREEN READER MODE to make this survey compatible with screen readers. Acute Dialysis Survey Question Title * 1. Please describe your specialty (Check all that apply): Nephrologist Intensivist Pediatric Specialist Physician other than nephrologist or intensivist Other (please specify) OK Question Title * 2. How many years have you been in practice In training < 5 years 5-10 years 11-20 years > 20 years OK Question Title * 3. Which Country are you located United States Canada Europe Asia Australia Africa South America Country (please specify) OK Question Title * 4. Your Hospital Type / Funding Public Private University-Affiliated Charitable Not in Hospital-based Practice Other… OK Question Title * 5. Which EHR do you utilize in your main hospital? EPIC Cerner Siemens Phillips Copra Meditech GE Health Care Dont use an EHR Other (please specify) OK Question Title * 6. Who is primarily responsible for decisions for starting, prescribing and delivering acute dialysis for critical ill patients at your institution? Primary ICU team Nephrology Team Multidisciplinary decision Other (please specify) OK Question Title * 7. Who manages the setup, therapy delivery and discontinuation of acute dialysis services (CRRT, IHD, SLED, PD) in your ICU’s ICU Nurses alone Dialysis nurses alone ICU and Dialysis nurses combined Dialysis technicians Dialysis service provided by an outsourced agency Not sure Other (please specify) OK Question Title * 8. Which guidelines do you follow for initiation and delivery of acute dialysis in your ICU patients Kidney Disease: Improving Global Outcomes (KDIGO) French Intensive Care Society (SRLF) Acute Dialysis Quality Initiative (ADQI) National Institute for Health and Care Excellence (NICE) KDIGO Controversies in AKI Society of Critical Care Medicine Guidelines Do not follow any standardized guidelines Other (please specify) OK Question Title * 9. What best describes your current approach to determining initiation of RRT for AKI? I offer dialysis only when there is evidence that the kidneys have failed and are not likely to recover I start only when conservative measures have failed to correct the indications for dialysis I start dialysis if the patient is anticipated to require renal support even in the absence of specific indications OK Question Title * 10. Which of the following statements regarding randomized clinical trials of timing of acute dialysis in critically ill patients published in the NEJM and JAMA do you agree with? Based on current indications to determine the time for initiating dialysis, over 40% of patients may not need dialysis. Patients initiated on dialysis in the absence of major complications have a higher rate of long-term need for dialysis. Withholding dialysis until there is prolonged oliguria and severe complications is associated with higher mortality. The current criteria for initiating acute dialysis are inadequate in determining when dialysis should be initiated or stopped. There is no survival benefit of early vs late start of dialysis based on the criteria used in the clinical trials. Other (please specify) OK Question Title * 11. Based on your experience of acute dialysis in your hospitals, please select the percentage of patients who meet each of the following conditions. The total should be 100%. Dialysis is started in patients who did not need it. Dialysis is started in patients are unlikely to benefit and it is futile. Dialysis is started for emergent life-threatening indications. Dialysis is planned and started when patient is most likely to benefit. Dialysis is offered as a trial of therapy. OK Question Title * 12. How often do you have delays in starting dialysis and what are the main reasons for these delays? Vascular Access placement Other Procedures e.g. imaging are prioritized ICU staffing not available Dialysis staff not available CRRT or Dialysis machines or supplies not available Delay less than 2 hours from orders Delay less than 2 hours from orders Vascular Access placement Delay less than 2 hours from orders Other Procedures e.g. imaging are prioritized Delay less than 2 hours from orders ICU staffing not available Delay less than 2 hours from orders Dialysis staff not available Delay less than 2 hours from orders CRRT or Dialysis machines or supplies not available Delay for more than 2 to upto 4 hours Delay for more than 2 to upto 4 hours Vascular Access placement Delay for more than 2 to upto 4 hours Other Procedures e.g. imaging are prioritized Delay for more than 2 to upto 4 hours ICU staffing not available Delay for more than 2 to upto 4 hours Dialysis staff not available Delay for more than 2 to upto 4 hours CRRT or Dialysis machines or supplies not available Delay for more than 4 upto 6 hours Delay for more than 4 upto 6 hours Vascular Access placement Delay for more than 4 upto 6 hours Other Procedures e.g. imaging are prioritized Delay for more than 4 upto 6 hours ICU staffing not available Delay for more than 4 upto 6 hours Dialysis staff not available Delay for more than 4 upto 6 hours CRRT or Dialysis machines or supplies not available Delay more than 6 hours Delay more than 6 hours Vascular Access placement Delay more than 6 hours Other Procedures e.g. imaging are prioritized Delay more than 6 hours ICU staffing not available Delay more than 6 hours Dialysis staff not available Delay more than 6 hours CRRT or Dialysis machines or supplies not available Other (please specify) OK Question Title * 13. Spending for hospitalizations with acute dialysis has showed an increase of over $40,000 in hospitalization costs, an increase in length of stay by almost two weeks and rehospitalization rates >30% within 3 months, has prompted the CMS to track the expenses associated with each dialysis linked to providers and establish this as a cost measure for value based payments to physicians (2021 CMS Cost Measure #20) https://qpp.cms.gov/docs/cost_specifications/2019-12-17-mif-ebcm-aki-new-hd.pdf). In your opinion, which of the following would be most important in reducing the cost of acute dialysis and improving outcomes in these patients. Identify and track high risk patients who will require dialysis to optimize timely decisions for therapy application Standardize the timing, delivery and monitoring of acute dialysis to reduce variation in therapy application Improve communications among care team and with patients and surrogates for shared decision making Improve service efficiency and resource management to prevent crisis management for dialysis delivery Personalize dialysis delivery based on predictive analytics accounting for patient characteristics and process of care elements Other (please specify) OK Question Title * 14. Consider the following facts:Requirement of acute dialysis in the hospital is associated with 30-50% hospital mortality, survivors more likely to die within 12 months. At hospital discharge < 30% go home; 40% re-hospitalized within 1 year. Please rank order the following factors in order of importance to be prioritized for managing acute dialysis to improve these outcomes. OK Question Title * 15. Given the complexity of care of patients with multi-organ failure requiring organ support, which of the following features would you be most likely to utilize in a clinical decision support system for acute dialysis based on predictive models validated over > 100,000 patients across 5 international centers with excellent discrimination (AUC >0.95), calibration, and positive and negative predictive values. OK Question Title * 16. Based on recommendations from a Clinical decision support system for acute dialysis how likely are you to Adjust Timing of starting dialysis to earlier than my current prcatice Wait longer to start dialysis than I currently do Feel more comfortable not starting a futile patient Have agreement with other team members to decide goals of therapy Have better agreements with other clinicians on when to start and stop dialysis Be more confident in explaining dialysis need to patients family Transition or stop dialysis Will not follow CDSS Will not follow CDSS Adjust Timing of starting dialysis to earlier than my current prcatice Will not follow CDSS Wait longer to start dialysis than I currently do Will not follow CDSS Feel more comfortable not starting a futile patient Will not follow CDSS Have agreement with other team members to decide goals of therapy Will not follow CDSS Have better agreements with other clinicians on when to start and stop dialysis Will not follow CDSS Be more confident in explaining dialysis need to patients family Will not follow CDSS Transition or stop dialysis <25% <25% Adjust Timing of starting dialysis to earlier than my current prcatice <25% Wait longer to start dialysis than I currently do <25% Feel more comfortable not starting a futile patient <25% Have agreement with other team members to decide goals of therapy <25% Have better agreements with other clinicians on when to start and stop dialysis <25% Be more confident in explaining dialysis need to patients family <25% Transition or stop dialysis 25-50% 25-50% Adjust Timing of starting dialysis to earlier than my current prcatice 25-50% Wait longer to start dialysis than I currently do 25-50% Feel more comfortable not starting a futile patient 25-50% Have agreement with other team members to decide goals of therapy 25-50% Have better agreements with other clinicians on when to start and stop dialysis 25-50% Be more confident in explaining dialysis need to patients family 25-50% Transition or stop dialysis 51-75% 51-75% Adjust Timing of starting dialysis to earlier than my current prcatice 51-75% Wait longer to start dialysis than I currently do 51-75% Feel more comfortable not starting a futile patient 51-75% Have agreement with other team members to decide goals of therapy 51-75% Have better agreements with other clinicians on when to start and stop dialysis 51-75% Be more confident in explaining dialysis need to patients family 51-75% Transition or stop dialysis > 75% > 75% Adjust Timing of starting dialysis to earlier than my current prcatice > 75% Wait longer to start dialysis than I currently do > 75% Feel more comfortable not starting a futile patient > 75% Have agreement with other team members to decide goals of therapy > 75% Have better agreements with other clinicians on when to start and stop dialysis > 75% Be more confident in explaining dialysis need to patients family > 75% Transition or stop dialysis Other (please specify) OK Question Title * 17. In your opinion which other areas of predictive models for clinical decision support would be needed to improve patient outcomes? AKI Prediction Sepsis Need for Ventilators Transition / Stopping Therapy Readmission (within 30 days) Other (please specify) OK DONE