RESULTS: During the pre-intervention period, 54 patients [median age 61 (52-68) years, 35 (65%) males] met the inclusion criteria. Survey of physicians, physician extenders, nurses and pharmacists [110/152 (72%) respondents] revealed a lack of familiarity with alternatives (29%) and poor accessibility (16%) as common barriers to the use of LR vs. NS. High serum chloride (28%), high serum sodium (26%) and increasing serum creatinine (16%) were factors influencing fluid choices. PDSA cycles addressing education, availability and stocked solutions were designed. Following the intervention period, between January and March 2016, 22 patients were included [median age 59 (39-68) years, 18 (82%) males]. Baseline characteristics were comparable between groups. Primary outcome of NS use (2.4 (1.3-3.7) L vs. 1.5 (0.8-2.5) L, P=0.36) and bolus use (1.0 (0.5-2.0) L vs. 0.7 (0.3-1.0) L, P=0.31) was not different between groups. 24-hour bolus NS use was lesser in the post-intervention cohort (1.0 (0.6-1.8) L vs. 0.7 (0.3-1.0) L, P<0.001). Secondary outcomes of percentage NS total and bolus use, 24-hour use, AKI and ICU LOS were not different between groups. Counter balance measures of provider satisfaction, effective workflow and hyperkalemia were evaluated.