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BMJ Quality Improvement report
Introducing an AKI predictive tool for patients undergoing orthopaedic surgery
  1. David Paul Baird1,
  2. Fraser Rae2,
  3. Christina Beecroft3,
  4. Katherine Gallagher4,
  5. Stephanie Sim5,
  6. Robert Vaessen5,
  7. Emily Wright1,
  8. Samira Bell1,6
  1. 1 Renal Medicine, Ninewells Hospital, Dundee, UK
  2. 2 Orthopaedic Department, Perth Royal Infirmary, Perth, Perth and Kinross, UK
  3. 3 Anaesthetic Department, Ninewells Hospital, Dundee, UK
  4. 4 Department of Medicine, Perth Royal Infirmary, Perth, Perth and Kinross, UK
  5. 5 Anaesthetic Department, Perth Royal Infirmary, Perth, Perth and Kinross, UK
  6. 6 Division of Population Health and Genomics, University of Dundee, Dundee, UK
  1. Correspondence to Dr David Paul Baird; d.baird1{at}nhs.net

Abstract

Patients undergoing surgery are at increased risk of acute kidney injury (AKI). AKI is associated with adverse outcomes such as increased mortality and future risk of developing chronic kidney disease. We have developed a validated preoperative scoring tool to predict postoperative AKI in patients undergoing orthopaedic surgery using seven readily available parameters. The aim of this project was to establish the use of this scoring tool with a target compliance of 80% in patients undergoing orthopaedic surgery requiring an overnight stay at Perth Royal Infirmary, a district general hospital in NHS Tayside. We created an intervention bundle for patients at high risk of AKI, which we defined as greater than 10%. An electronic tool available on smartphones and desktop computers was developed that can be used to calculate the score. The interventions were incorporated into the electronic tool and posters outlining the intervention were placed in clinical areas. Patients undergoing elective procedures were scored in the preassessment clinic while emergency patients were scored by the admitting doctors. The score was introduced using four PDSA cycles. This confirmed that the scoring tool functioned well and was being used accurately. Compliance for patients undergoing elective surgery was reasonable at 19/24 (79%) in the third and fourth PDSA cycles but was poorer for emergency admissions with compliance of only 3/7 (43%). There was excellent compliance with the suggested medication changes and postoperative blood test monitoring as advised by our intervention bundle for those at high risk of AKI. Fluid balance monitoring was advised for all patients but the outcome was similar following our intervention at 27/41 (66%) compared with 23/37 (62%) in the baseline data collection. Compliance with fluid balance monitoring was higher in patients at high risk of AKI (9/12, 75%).

  • anaesthesia
  • healthcare quality improvement
  • hospital medicine
  • pdsa
  • surgery

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjoq-2017-000306

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    Footnotes

    • Contributors DPB was involved in the collection of the baseline data, developing the intervention bundle and liaising with the relevant teams prior to implementation. He was also responsible for writing the first draft of the manuscript and is responsible for overall content as guarantor. SB was responsible for developing and validating the scoring tool and conceived the idea of using it alongside an intervention bundle to reduce the risk of AKI. She also contributed to the development of the intervention bundle. EW was involved in collecting the baseline data for the project while FR was responsible for collecting the data following the introduction of the scoring tool and intervention bundle. KG was responsible for developing the electronic tool that allowed the score to be used on smartphones and desktop computers. CB, RV and SS all contributed to the design of the baseline data collection and the development of the intervention bundle. All authors critically revised the manuscript for important intellectual content, gave their final approval of the version to be published and agree to be accountable for all aspects of the work.

    • 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.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.