J QIAN1, S KOTWAL1,2, S HERATH1, J ERLICH1, D CHRISTIADI1, Z ENDRE1
1Department of Nephrology and Prince of Wales Clinical School, UNSW, Sydney, Australia, 2The George Institute for Global Health, UNSW, Sydney, Australia
Aim: Implementation of a package of interventions to standardise management of AKI.
Background: AKI is a frequent, under-reported complication of hospital admission associated with poor clinical outcomes. Early identification of AKI is associated with reduced mortality and health care costs. Conversely, late identification and increased severity of AKI may increase costs, partly by increasing length of stay (LOS).
Methods: This prospective cohort study included all hospitalised patients (>18 years) meeting KDIGO-derived laboratory criteria for a first episode of AKI between 22/04/2019 and 31/10/2019 across the South East Sydney hospital network.
The intervention comprised: 1) automated AKI detection based on serum creatinine, 2) a disruptive electronic alert (e-Alert), 3) a “STOP-AKI” management guide and 4) JMO education. The intervention was implemented at Prince of Wales Hospital (intervention site) and not at St George Hospital nor The Sutherland Hospital (control sites).
The primary outcome was LOS. Secondary outcomes included documentation of AKI and creatinine threshold for nephrology consultations – a surrogate for early referral. Centralised eMR access allowed remote data collection and follow-up until discharge for all patients.
Results: A first episode of AKI was identified in 614 patients (intervention group, 250 patients; control, 364). There was no difference in LOS between control and intervention groups (both median 10 days; p=0.47). Documentation of AKI was greater in the intervention group (94.4%) compared to control (84.4%). Nephrology consultations were requested more frequently (p=0.06) and at a lower creatinine threshold in the intervention group (median Cr 217 umol/L; p=0.007) compared to the control group (median Cr 279 umol/L).
Conclusions: Implementation of the intervention package improved AKI documentation without impacting length of hospital stay.
Dr Kotwal is a nephrologist at Prince of Wales Hospital in Sydney and a post-doctoral research fellow at the George Institute of Global Health. Dr Kotwal has expertise in epidemiology, biostatistics, the analysis of linked health data and evidence implementation research.