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Sykes L, Sinha S, Hegarty J, Flanagan E, Doyle L, Hoolickin C, Edwards L, Ferris P, Lamerton E, Poulikakos D, Green D, Nipah R. Reducing acute kidney injury incidence and progression in a large teaching hospital. BMJ Open Qual 2018; 7:e000308. [PMID: 30555931 PMCID: PMC6267307 DOI: 10.1136/bmjoq-2017-000308] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 09/13/2018] [Accepted: 10/12/2018] [Indexed: 11/04/2022] Open
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.
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Affiliation(s)
- Lynne Sykes
- Emergency Admission Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Smeeta Sinha
- Renal Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Janet Hegarty
- Renal Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Emma Flanagan
- Information Management and Technology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Liam Doyle
- Quality Improvement, Salford Royal NHS Foundation Trust, Salford, UK
| | - Chedia Hoolickin
- Quality Improvement, Salford Royal NHS Foundation Trust, Salford, UK
| | - Lewis Edwards
- Quality Improvement, Salford Royal NHS Foundation Trust, Salford, UK
| | - Paul Ferris
- Intensive Care, Salford Royal NHS Foundation Trust, Salford, UK
| | | | | | - Darren Green
- Emergency Admission Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Robert Nipah
- Emergency Admissions Unit, Royal Preston Hospital, Preston, UK
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