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Research Snapshot Theater: Quality and Patient Safety, Pediatric V

Sustained Protein Delivery Gains in Pediatric CRRT: A Four-Cycle PDSA Quality Initiative

Monday, March 23, 2026
2:30 PM - 3:30 PM Central Time
Location: Connections Central - RST 10

  • Molly R. Vega, RD, PhD (she/her/hers)

    Baylor College of Medicine Texas Children's Hospital, Texas

    Disclosure(s): Academy of Nutrition & Dietetics: Grant/Research Support (Ongoing); Vitaflo, LLC: Speaker/Honoraria (includes speakers bureau, symposia, and expert witness) (Ongoing)

  • ST

    Sameer Thadani, MD

    Baylor College of Medicine Texas Children's Hospital, Texas

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • PS

    Poyyapakkam Srivaths, MD, FAAP

    Dr.
    Baylor College of Medicine Texas Children's Hospital

    Disclosure information not submitted.

  • AA

    Ayse Akcan Arikan, MD

    Baylor College of Medicine at Texas Childrens Hospital, Texas

    Disclosure information not submitted.

Introduction: Protein-energy wasting affects 31–40% of pediatric CRRT patients, increasing morbidity and mortality. At our institution, only 27% met protein goals (≥2.5 g/kg/day) by CRRT day 5. Prior PDSA cycles (1–3; n=49) incorporating a multidisciplinary team (intensivists, nephrologists, dietitians, pharmacists) improved delivery through EHR templates (PDSA1), education (PDSA2), and thrice-weekly bedside audits (PDSA3).


Methods: From 2019–2024, we implemented PDSA4, a sustainability phase involving monthly benchmarking with leadership review (n=296). Outcomes (mean protein delivery, goal attainment, severe deficits) were compared to prior PDSA cycles.


Results: Protein delivery improved from 1.79±0.93 g/kg/day (PDSA1) to 2.47±0.94 (PDSA4), a 38% increase. The largest gain occurred in PDSA3 (2.97±0.71), a 66% increase over baseline (p=0.024), with 85.7% achieving protein goals. Although PDSA4’s broader inclusion reduced mean intake (2.47 vs. 2.97, p=0.358), the most recent 100 patients maintained an 83% goal achievement rate, confirming sustainability. Severe protein deficits ( < 1.5 g/kg/day) decreased from 36% to 7%. The overall improvement was statistically significant (Kruskal-Wallis χ²=12.29, p=0.006).


Conclusions: Real-time audits (PDSA3) closed knowledge-to-practice gaps, while leadership benchmarking (PDSA4) sustained gains through accountability. The non-significant difference between PDSA3 and PDSA4 (p=0.358) suggests a performance plateau, with PDSA4 successfully scaling improvements to a larger cohort. This QI initiative elevated protein goal attainment from 27% to 83%, informing two system-level changes: embedded EHR protein recommendations and a standardized nutrition rounding checklist. Our experience demonstrates that structured, multidisciplinary QI initiatives can overcome barriers to optimal nutrition delivery in pediatric CRRT, offering a replicable, scalable, and sustainable model for other high-risk populations.