What did we do?
We supported the delivery and evaluated quality improvement (QI) initiatives which aimed to improve the identification and reduce the number of cases of Acute Kidney Injury (AKI) at two secomdary care hospital providers.
QI work at Secondary Care Hospital Provider A:
The QI work at the Trust was designed around two specialist AKI nurses who form part of the renal team. The specialist nurses are responsible for supporting staff from all wards that provide care for people with AKI.
A QI programme was launched in 2013, as part of this improvement work the Trust established targets associated with:
- Improved identification of AKI;
- Reduction in progression from AKI stage one to stage two and three;
- Reduction in length of stay associated with AKI.
The initial programme was completed in June 2014. During this time, the Trust achieved substantial reductions in length of stay associated with AKI. The renal team then conducted a factor analysis to identify the most important determinants of this reduction. They identified:
- Face-to-face contact with specialist nursing team;
- Checklist for ward staff.
QI work at Secondary Care Hospital provider B:
The AKI initiative at Hopsital B uses a QI collaborative approach, meaning that AKI is 'everyone's problem' for the participating wards.
Following an initial learning event in August 2015, the Trust had a three month “action period” during which time doctors, nurses and support workers tested new ideas such as:
- Posters and leaflets to raise awareness of AKI among the staff;
- Information leaflets for patients and relatives;
- Establishing processes for the timely analysis of urine and blood tests;
- Ensuring fluid balance charts are documented rigorously for AKI patients;
- Developing an AKI alert on the electronic patient record;
- Developing an education programme and ongoing one-to-one teaching at ward level;
- Developing an AKI resource pack for staff that includes tools and guidance.
Why is it important?
We know that AKI increases mortality in the short to long term, in the UK, up to 100,000 deaths each year are associated with AKI. Up to 30% of these deaths could be prevented with the right care and treatment (NCEPOD, Adding Insult to Injury, 2009). AKI is common, harmful, costly and preventable and accounts for up to one in five emergency admissions into hospital.
How will we do it?
This project has three elements:
- We will seek to understand the experience of care for patients who have an episode of care complicated by AKI.
- We will support the delivery of the QI initiative at Hospital B with project management and facilitation.
- We will evaluate the implementation of both AKI and QI initiatives at Hospitals A and B.
- Evaluation Reports
- News Stories
Understanding context in quality improvement: Ethnographic hospital case studies of AKI improvement initiatives - Lynn Sykes, Clara Weisshaar, Tom Blakeman, Simon Bailey & Adam Brisley