Article Text
Abstract
Acute kidney injury (AKI) is a common syndrome that is associated with significant mortality and cost. The Quality Improvement AKI Collaborative at Salford Royal Foundation Trust was established to review and improve both the recognition and management of AKI. This was a whole-system intervention to tackle AKI implemented as an alternative to employing separate AKI nurses. Our aims were to reduce the overall incidence of AKI by 10%, to reduce hospital-acquired AKI by 25% and to reduce the progression of AKI from stage 1 to stage 2 or 3 by 50%.
From 2014 to 2016, several multifaceted changes were introduced. These included system changes, such as inserting an e-alert for AKI into the electronic patient record, an online educational package and face-to-face teaching for AKI, and AKI addition to daily safety huddles. On 10 Collaborative wards, development of an AKI care bundle via multidisciplinary team (MDT) plan, do, study, act testing occurred.
Results showed a 15.6% reduction in hospital-wide-acquired AKI, with a 22.3% reduction on the collaborative wards. Trust-wide rates of progression of AKI 1 to AKI 2 or 3 showed normal variation, whereas there was a 48.5% reduction in AKI progression on the Collaborative wards. This implies that e-alerts were ineffective in isolation. The Collaborative wards’ results were a product of the educational support, bundle and heightened awareness of AKI.
A number of acute hospitals have demonstrated impactful successes in AKI reduction centred on a dedicated AKI nurse model plus e-alerting with supporting changes. This project adds value by highlighting another approach that does not require a new post with attendant rolling costs and risks. We believe that our approach increased our efficacy in acute care in our front-line teams by concentrating on embedding improved recognition and actions across the MDT.
- collaborative, breakthrough groups
- continuous quality improvement
- control charts/run charts
- healthcare quality improvement
- quality improvement
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Footnotes
Contributors LS: AKI Collaborative member, developed educational material, analysed data, wrote manuscript, edited and submitted manuscript. SS: AKI working group lead, formed AKI collaborative, developed project, edited and approved final draft. JH: AKI working group and AKI collaborative member, edited and approved of final draft. EF: AKI Collaborative member, provided data support, approved final draft. LD: AKI Collaborative member, Quality Improvement lead on project, planned and delivered learning sessions, provided SPC charts, approved final draft. CH: AKI Collaborative member, planned and delivered learning sessions, approved final draft. LE joined AKI Collaborative and provided QI support, planned and delivered learning sessions, approved final draft. PF: AKI Collaborative, edited and approved final draft. EL: AKI Collaborative, lead pharmacy work stream, approved final draft. DP: AKI Collaborative member, approved final draft. DG: internal peer review, quality assurance of data, edited and approved final draft. RN: AKI lead formed AKI Collaborative, developed and lead on project, and approved final draft.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Ethics approval As this was a QI study using anonymised data collection for both analysis and reporting, it is exempt from specific ethical approval.
Provenance and peer review Not commissioned; externally peer reviewed.
Collaborators AKI Collaborative: Rob Nipah (Acute Medical Consultant), Liam Doyle, Chedia Hoolickin and Lewis Edwards (Quality Improvement), Dimitrios Poulikakos, Janet Hegarty and Smeeta Sinha (renal consultants), Lynne Sykes (clinical research fellow), Elizabeth Lamerton (Pharmacy), Lynn Sterling (Learning and Development), Emma Flanagan (Information Management and Technology), Paul Johnston (Electronic Patient Records), Adam Brisley and Simon Bailey (Manchester University), Paul Ferris (Intensive Care Consultant), Gareth Byrne (Clinical audit, Improving quality data), Jill Carlin (clinical director of Radiology), Denise Darby (Pathology), Debra Lee (Lead nurse), Julie Newton (lead nurse acute medicine), Gaynor White and Julie Winstanley (Emergency Admissions Unit), Susan Howard, Delphine Corgie and Zoe Ashton (NIHR CLAHRC North West. The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester is a partnership between providers and commissioners from the NHS,industry, the third sector and the University of Manchester. We aim to improve the health of people in Greater Manchester and beyond through carrying out research and putting it into practice. (http://clahrc-gm.nihr.ac.uk). AKIcare app developers, Greater Manchester, Lancashire and South Cumbria Strategic Clinical Networks, Rachel Challiner, James Ritchie.