A whole system approach to improving mortality associated with acute kidney injury

QJM : Monthly Journal of the Association of Physicians
T ChandrasekarKottarathil A Abraham

Abstract

Acute kidney injury (AKI) is in the main managed by non-nephrologists, many who feel challenged by or lack awareness of the complexity that the renal element adds to their patients' care. National reports have raised major concerns about the quality of care and have predicted that mortality reductions of 30% are achievable with good medical practice. This quality improvement project evaluated whether a whole system approach could improve outcomes for patients with AKI. Quality improvement methodology was used to understand hospital patterns, processes and professional knowledge. Change concepts were developed which included management of patients at risk, staff education and awareness program, development of a patient specific electronic alert to prompt diagnosis, easy to remember care bundle (ABCDE-IT), dedicated outreach team and patient and family empowerment leaflet. Statistical process control analysis was used to verify outcomes over time. A shift in the in-hospital mortality rate corresponded to a relative 23.2% reduction in mortality and was sustained over the next 33 months (P < 0.0001). The favourable shift in mortality was temporally distinct from the improved AKI detection rate. This timeframe corresponded to lying ...Continue Reading

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Citations

Dec 1, 2017·Journal of Nephrology·Lynne SykesDarren Green
Nov 30, 2018·QJM : Monthly Journal of the Association of Physicians·UNKNOWN Risk Investigators
Mar 7, 2020·Journal of Clinical Medicine·Joana GameiroJosé António Lopes
May 7, 2019·Journal of the American Society of Nephrology : JASN·Nicholas M SelbyFergus J Caskey
Jul 18, 2020·Clinical Medicine : Journal of the Royal College of Physicians of London·Pauline HeslopClare Wade
Jul 11, 2018·International Journal of Sport Nutrition and Exercise Metabolism·Andreas M KasperJames P Morton
Aug 2, 2019·Journal of Medical Internet Research·Alistair ConnellChristopher Laing
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Apr 23, 2020·Clinical Journal of the American Society of Nephrology : CJASN·Kathleen D LiuUNKNOWN AKI!Now Initiative of the American Society of Nephrology
Jul 25, 2021·Hospital Pediatrics·Elizabeth A S GoswamiJeffrey J Fadrowski

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