SHM Converge Scientific Abstract ePoster Gallery-Need to Diurese? Rapid Effective Diuresis Nurse Driven Ed Pathway Improving Diuretic Timing and Dosing. Go Red!

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The document describes a nurse-driven emergency department pathway for patients with acute decompensated heart failure called the Rapid Effective Diuresis (RED) PennPathway. The background highlights the large burden of heart failure in the U.S., including frequent hospitalizations, long lengths of stay, and high costs. The pathway was developed to improve early and adequate diuresis within the first 6 hours of ED presentation, with the goal of reducing delays, improving patient outcomes, and preventing escalation of care.<br /><br />The RED PennPathway uses an evidence-based order set that allows ED nurses to give a second IV diuretic dose without delay when response to the first dose is inadequate. A spot urine sodium level obtained within 2 hours of the initial diuretic dose is used to assess natriuresis and determine whether escalation is needed. The institution uses a urine sodium threshold of 70 mmol/L to indicate adequate diuresis. This approach is intended to reduce the long delays that can occur between provider-ordered diuretic doses, sometimes exceeding 12 hours.<br /><br />The pathway became active health-system wide on October 25, 2025. By February 17, 2026, it had been used in 1,282 unique patients, with 281 orders in the first month after launch. Safety monitoring has been reassuring, with zero significant adverse events reported. Specifically, no clinically significant arrhythmias, acute kidney injury, or electrolyte abnormalities were observed. Early results also showed a significant reduction in length of stay and improved observed-to-expected length of stay during the first four months of implementation.<br /><br />Overall, the RED PennPathway appears to be a feasible and safe strategy to improve timely diuresis in the ED for heart failure patients while potentially reducing hospital stay.

Asset Subtitle

Deneen M. Spatz

Meta Tag

Author List Deneen M. Spatz

Category Innovations

Concept Acute Decompensated Heart Failure

Concept Diuresis

Concept Rapid Effective Diuresis PennPathway

Concept IV Diuretics

Concept Urine Sodium

Distinguished Non-Finalist

Presenter Organization Hospital of the University of Pennsylvania

Presenting Author Deneen M. Spatz

Track Quality Improvement

Keywords

heart failure

acute decompensated heart failure

emergency department

nurse-driven pathway

Rapid Effective Diuresis

RED PennPathway

intravenous diuretics

urine sodium

diuresis

length of stay

Acute Decompensated Heart Failure

Diuresis

Rapid Effective Diuresis PennPathway

IV Diuretics

Urine Sodium