When introduced to hospitals in the United Kingdom, a multifaceted intervention designed to reduce avoidable harm associated with acute kidney injury improved delivery of care, which subsequently led to better outcomes for patients with AKI, according to a study published in the Journal of the American Society of Nephrology.
“Although the intervention to improve standards of care for patients with AKI did not alter mortality, there were other important benefits seen,” Nicholas Selby, MD, associate professor of nephrology at the Centre for Kidney Research and Innovation at the University of Nottingham, told Healio/Nephrology. “These included a shorter length of hospital stay, shorter duration of AKI episodes and improved recognition of the condition. These results support a continued focus on improving the delivery of person-centred AKI care across acute specialities.”
To test the efficacy of an intervention for improving both the delivery of care and patient outcomes, researchers conducted a pragmatic, multicenter, cluster-randomized trial at five hospitals, studying 20,179 adult patients with AKI. During the 27-month study period, researchers delivered the intervention sequentially to one hospital at a time across fixed 3-month periods, creating a control period and an intervention period. The intervention consisted of an AKI electronic detection and alerting system, an AKI care bundle relating to assessment, investigation and basic management of AKI, and an educational program to raise awareness and knowledge of AKI in health care workers.
The primary outcome of the study was 30-day mortality. Secondary outcomes included the incidence of hospital-acquired AKI, AKI progression, the incidence of individual AKI stages and length of hospital stay. A nested evaluation of care process delivery was also performed.
A multifaceted intervention designed to reduce avoidable harm associated with acute kidney injury improved delivery of care, which subsequently led to better outcomes for patients with AKI.
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During the study period, there were a total of 24,059 AKI episodes (14,042 in control; 10,017 in intervention). Researchers found no difference between the control period and the intervention period with regard to 30-day mortality (24.5% across the entire study period; OR = 1.04), but the intervention was associated with a reduction in hospital length of stay. Researchers also observed improvements in AKI recognition, medication optimization and fluid assessment, along with a shorter duration of AKI episodes during the intervention period.
“[Further investigation should include] a health economic analysis of this approach to determine if the reduction in hospital length of stay translates into improvements in health resource utilization and cost savings, [along with an attempt] to refine the intervention and its implementation to see if this can result in further improvements in patient outcomes,” Selby said. – by Melissa J. Webb
The authors report no relevant financial disclosures.