Putting effort into minimising acute kidney injury? It’s a no-brainer

Participants at the Strategic Clinical Network acute kidney injury event in November 2015.

By Dr Susan Howard, Programme Manager

Dr Susan Howard tell us why it’s absolutely critical to keep trying to make local improvements in acute kidney injury care.

So this is my first ever blog – yes, I know! I realise that’s akin to admitting you don’t own a smartphone in this day and age (which I do, before you click away in disgust). In preparation for this great day I have been semi-eagerly searching for blog-writing guidance, and before I get onto the topic of the day, I thought it would help to share my learning here too: 1) avoid making it dry, 2) make it personal, and 3) include thoughts and opinions as well as facts. Let’s do this!

So my day (on the Wednesday 25 November 2015) started with three large cups of tea (avoid making it dry – tick), this is now starting to cause me some discomfort (personal and thoughts – tick). My work here is done! But oh yeah, this event I’m at, which is the purpose of my blog mission…

Today I’m at the ‘improving care in acute kidney injury: sharing best practice’ event in Blackrod, organised by the Greater Manchester, Lancashire and South Cumbria Strategic Clinical Networks. There’s a LOT of activity around acute kidney injury (AKI – the ‘canary in the mine of sick people’) going on around the North West (and beyond); want to hear more about what’s going on at the cutting edge and future plans/ideas? Then read on.

AKI seems to be one of the buzz topics of the moment. And it’s not surprising considering the potential for impact if we can minimise it; one in five emergency hospital admissions have AKI, it costs the NHS £434-620 million every year, and it’s estimated that 20% of cases are preventable. The term ‘no -brainer’ comes to mind. But if it was that easy, we’d probably already be doing it, right?

It was fab to see so many people keen to work together.

It was fab to see so many people keen to work together.

Richard Fluck opened proceedings, to a very full room, with a broad view on AKI activity and the work of Think Kidneys. He identified one of the key challenges around improving AKI care as being the fact it needed a wide call to action, involving almost all clinical areas/healthcare professionals across secondary and primary care. Fortunately the UK is in an almost unique position of being a healthcare system that can look at integrated improvement throughout the pathway.

One of the barriers appears to be the perception that kidney issues are the exclusive remit of the renal specialist. Yet throughout the day, there were repeated reports demonstrating the benefit of greater education for a broad range of healthcare professionals. Definitive data on the clinical benefit requires further work, however.

The ‘how can we crack fluid balance and fluid management in AKI?’ discussion panel (Begho Obale, Sarah Ingleby, Emily Raybould, James Bonnar and Nigel Randall) presented the case for improved fluid balance chart accuracy and frequent review; it was felt this needs a fundamental organisational change. Panel members also shared that patient involvement has been invaluable in improving patient compliance and awareness of AKI.

Kidneys on the brain!

Kidneys on the brain!

The majority of secondary care trusts tackling AKI appear to be doing this primarily by using specialist nurses. Incidentally, our own work evaluating two approaches – specialist nurse model versus quality improvement (QI) collaborative which aims to include wide reaching input from ward staff – should hopefully be enlightening in understanding the pros and cons of different models of AKI care. The AKI lead from Wigan, Stephen Gulliford, nicely presented a case study demonstrating the benefits of a specialist approach. He also showed compelling data illustrating a significant reduction in length of hospital stay in patients with AKI following introduction of an AKI care bundle.

AKI event 251115 1

Our own stand was particularly busy, and it was great to speak to so many people about the work we’re doing.

In the last session of the day we went time travelling with our own Dr Tom Blakeman – looking back on our current primary care AKI efforts from the hindsight of 2025. Followed by John Anderton fighting the corner of the hospital-based initiatives in the ‘where should resources to tackle AKI be focussed?’ debate. The resounding response from the audience was resources need to be spread across the interface in order to tackle AKI effectively.

A great day was had by all. Lots of posters, interesting presentations/discussion, and an opportunity to swap notes and resources, and meet key regional players in AKI improvement work. It’s wonderful to hear about so much good work going on in our area, but it seems the evidence is still somewhat thin for many initiatives. Going forward, however, we need to evaluate our work carefully, and ensure we produce better evidence to effectively champion work around AKI, and to fend off the inevitable ‘show me the money’ question. Does that mean we shouldn’t try to make local improvements in the meantime? In my personal view – absolutely not.

Find out more about what we’re doing

At the NIHR CLAHRC Greater Manchester we’re supporting and evaluating a primary care  AKI prevention project in Salford and a QI collaborative and evaluation in secondary care with Salford Royal and Central Manchester University Hospitals NHS Foundation Trusts.