SAN DIEGO – A streamlined approach to the management of acute kidney injury led to a reduction in mortality rates and hospital length of stay, results from an observational study demonstrated.
“We can make significant improvement in AKI outcomes using simple interventions: risk assessment for AKI, medicine management for those at risk, an automated e-alert to ensure early detection that triggers an intervention bundle implemented by frontline staff, rapid referral to and review by nephrology, and empowering patients and caregivers to minimize risk,” study coauthor Dr. Thangavelu Chandrasekar said in an interview in advance of Kidney Week 2015.
Dr. Thangavelu Chandrasekar
Dr. Chandrasekar of the nephrology department at Aintree University Hospital, Liverpool, England, noted that AKI has a mortality rate of 30%, which is higher than that for myocardial infarction (8%) and stroke (9%). In their abstract, he and study coauthor Dr. Hsu Pheen Chong estimated that 15% of all inpatients at Aintree University Hospital suffer an AKI, “making it a condition of considerable importance in everyday practice.”
In an effort to reduce AKI mortality by 30% and length of stay by 20% at the hospital, the researchers used Plan-Do-Study-Act methodology to develop a project known as STOP-AKI.
Launched in October 2013, STOP-AKI consists of:
• A risk assessment for AKI in all medical admissions, with increased surveillance and medicine management for those at risk.
• An automated real-time electronic alert to ensure early detection that triggers an intervention bundle implemented by frontline staff who target any deteriorating patient.
• Rapid referral to and review by nephrology in patients who required renal inputs.
• The conveyance of verbal and written information about AKI to patients and their caregivers.
STOP-AKI was initially launched in the nephrology ward and then scaled up to become part of routine management for all patients admitted to the hospital.
The researchers found that from October 2013 through September 2015, AKI mortality rates fell from a baseline of 26% to 19%, which represented an overall reduction in mortality of 27%. At the same time, hospital length of stay fell by 13%, which amounted to a 2.7-day reduction in length of stay.
“Early identification and intervention are the key factors [in treating AKI],” Dr. Chandrasekar said. “Our study is proof for this, which has shown a significant drop in mortality and reduction in length of stay in hospitalized patients.
“We used a whole system approach with multiple interventions at different levels that dovetail with each other and [are] designed to empower health care professionals, including [the] most junior person to intervene effectively,” he added.
Dr. Chandrasekar and his associates are developing metrics to assess AKI progression and its predictors.
The researchers reported having no financial disclosures. The meeting was sponsored by the American Society of Nephrology.