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We know that AKI increases mortality in the short to long term, as stated by Think Kidneys, with ‘up to 100,000 deaths each year associated with AKI and up to 30% of these deaths could be prevented with the right care and treatment’ (NCEPOD, Adding Insult to Injury, 2009). To address this, an NHS England Patient Safety Directive mandated the introduction of an AKI alert system within all NHS Acute Foundation Trusts. Latest evidence shows that as part of a wider quality improvement intervention, AKI alert systems have the potential to improve care delivery and health outcomes. Our research shines a light on how this might be achieved.
NIHR CLAHRC Greater Manchester has evaluated the implementation of new AKI alert systems in two NHS Foundation Trusts in a project called Managing Acute Kidney Injury Together (MAKIT) for better health. Using qualitative methods, the study sought to gain an in-depth understanding of the work undertaken in both organisations to improve the identification and management of AKI.
The research team undertook a substantial number of observations and interviews with staff at each Trust to arrive at the findings and the main conclusions were:
- The Trusts used Institute of Health Improvement methods for quality improvement but in two different ways; one trust adopted a collaborative approach and sought improvement through awareness raising and system redesign; the other trust sought improvement through dedicated resourcing of two specialist AKI nurses.
- The Trusts reported notable improvements throughout the study against their targets for management of AKI. The most substantial gains were made in terms of hospital acquired AKI and in reducing the progression of minor to more severe cases.
- Tensions arose in both Trusts in terms of the policy requirements to introduce the new AKI alert and the resources allocated to achieve this goal.
- Both systems were designed in order to try and minimise over and under diagnosis of AKI. Dedicated resourcing is required in order for a reliable system to be devised to manage this.
The final MAKIT study report is now available here and describes the two different quality improvement methods adopted, how the adoption decisions were made and how the AKI work unfolded within each Trust.
For further information on these findings please contact Simon Bailey at firstname.lastname@example.org