NUHS EBP · MICU NUH Singapore
REINA
RRT Evidence-Based Integrated
Nursing & Attending Support
A bedside decision support tool for CRRT prescription — built for MICU use by nurses, residents, and attending physicians.
Phase 2 expert consultation · Thank you for your time
Phase 1 — deployed
Five taps. One prescription. Zero number entry.
Tap 1 — Indication
Why start RRT? Multi-select, emergency signals flagged
Tap 2 — Haemodynamics
Stable / vasopressor-dependent / shocked / post-resus
Tap 3 — Bleeding risk
Low / moderate / high / HIT / hepatic failure
Tap 4 — Special context
ECMO, liver failure, sepsis, dysnatraemia… (skippable)
Tap 5 — Weight
Range bands (<60 / 60–75 / >75 kg) or exact entry — still a choice, not a form field
Output: modality, anticoagulation, filter, prescribed dose, fluid ratios, and evidence rationale — in one screen.
MICU Protocol
REINA Upgrade
Clinician's Judgement
Three-tier evidence labelling on every recommendation. Protocol steps are blue. Evidence-upgraded guidance is amber. Situations needing clinical override are purple.
Why this consultation
Protocol lookup is fast.
But it doesn't think about this patient.
The protocol applies to the average patient
CRRT decisions are driven by combinations — fluid status, haemodynamics, comorbidities, circuit tolerance. Protocol v6 cannot individualise. REINA can, if it knows how you think.
Evidence exists but is not synthesised at the bedside
RENAL, STARRT-AKI, AKIKI, IVOIRE — literature is definitive on some questions, silent on others. REINA is building a GRADE-style evidence engine. Your expertise fills the remaining gaps.
Reasoning varies between consultants
Same patient, different attending — potentially a different prescription. Phase 2 makes senior clinical logic visible, consistent, and teachable at the bedside.
A platform to study our practice
Track decisions against outcomes. Understand what works in our MICU specifically. Build local evidence where RCTs don't exist.
CRRT decision trajectory — tap each stage
The full CRRT decision arc
→
→
→
→
→
→
Stop / Step
Discontinuation
Tap a stage above
Each stage has specific decision criteria, bedside signals, and failure pathways. This consultation captures your reasoning across all seven — the gaps in red are where your expertise matters most.
"What drives this decision for this specific patient, and why?"
Evidence coverage — tap any domain
9 decision domains · current status
I · Stop / Step
Not built yet
Tap a domain above
Green domains are built with evidence. Amber are protocol-based but need evidence validation. Red are Phase 2 — your reasoning becomes the clinical logic.
● Evidence-backed
● Protocol-based
● Input needed
What we are doing today
Your reasoning becomes the algorithm.
1
RRT initiation — when do you actually start?
Walk me through your decision: which signs make you start now vs watch and wait. Does your threshold shift with the clinical context?
2
Anticoagulation — how do you choose?
Your decision logic between citrate, heparin, and no anticoagulation. What factors override the default? What are your citrate red lines?
3
Filter selection — Oxiris or M100?
When do you reach for Oxiris? Is there a specific patient phenotype? How do you assess whether it's working?
4
Dose — do you ever deviate, and why?
Protocol targets 25–35 mL/kg/h delivered. When do you go higher or lower, and what drives that call?
5
Stopping and stepping down
How do you decide when CRRT is no longer needed? What's your process for transitioning to IHD or off RRT entirely?
Structured question set follows. No right answers — capturing how you actually think and practice at the bedside.