Quality Improvement Protocol for Early Recognition and Management of AKI Patients

Abstract

Acute kidney injury (AKI) is an absolute increase of serum creatinine of 0·3 mg/dL (within days or hours) (Khwaja, 2012). It is a common but serious problem among hospitalised patients. It has been linked to higher rates of mortality and morbidity, and to extended hospitalisation. The optimal way to reduce the risk of AKI is to detect risk factors as soon as possible; however, clinicians still struggle with early detection. Against this background, new technology and approaches for early detection of AKI risk factors is crucial.

Aim The current research seeks to ascertain the state of the art in clinical interventions among hospitalised patients that minimise or eliminate hospitalisation and mortality due to AKI. The central factor here is the timely detection of abnormal creatinine levels in patients. This in turn demands three things. Firstly, effective follow-up of alerts in the context of AKI clinical treatment is essential. Secondly, all clinical staff must be fully trained and equipped, especially in terms of risk assessment and follow-up so that pathologies are detected in time. Finally, timely inter-team communication and commitment is critical to make sure that patients are attending nephrology consultations early and often.

Methodology Given the constraints of time and resources, a big part of planning was carrying out the literature review. The focus on the present study was on analysing the state of the art in clinical interventions to boost AKI management and outcomes rather than the entire list. We adopted the plan-do-study-act (PDSA) approach in which pilot tests were used to assess intervention effectiveness for later implementation on wider scales to boost overall AKI quality improvement.

Findings The findings show that improved clinical outcomes in terms of patient safety and quality of care can be achieved through timely alerts of abnormal creatinine levels. Nevertheless, in practice the electronic system of alerts was implemented in the absence of effective staff training and guidance, thus negating any of the gains. In contrast, implementation of the so-called care bundle produced better results in terms of clinical mortality rates and AKI deterioration, especially when embedded in more effective clinical training and guidance. For this reason, the current report recommends that the e-alerts system be integrated into more practical aspects, like staff training, inter-team working and the AKI care bundle.