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There is a substantial disparity between the opinions of nephrologists and actual processes of care for nephrology evaluation of patients after hospitalization with severe AKI.

This series does not demonstrate an advantage for rapid diagnosis and surgery, in terms of resection rate and survival. However, further study is required in a larger cohort of patients, to confirm these findings.

Analysis 1.32. Comparison 1 Pre-emptive versus deferred correction, Outcome 32 Patient outcomes: infections (IRR). Analysis 1.33. Comparison 1 Pre-emptive versus deferred correction, Outcome 33 Patient outcomes: mortality (RR). Analysis 2.1. Comparison 2 Two surveillance methods versus one, Outcome 1 Access thrombosis (RR).. .. .. Analysis 2.2. Comparison 2 Two surveillance methods versus one, Outcome 2 Health resource use: angioplasties (RR). Analysis 3.1. Comparison 3 Blood flow versus monitoring and venous pressure in grafts, Outcome 1

BackgroundThe outcomes of acute kidney injury (AKI) are well appreciated. However, valid indicators of high quality processes of care for AKI after major surgery are lacking.ObjectivesTo identify indicators of high quality processes of care related to AKI prevention, identification, and management after major surgery.DesignA three stage modified Delphi process.SettingThe study was conducted in Alberta, Canada using an online format.ParticipantsA panel of care providers from surgery, critical care, and nephrology.MeasurementsThe degree of validity of candidate indicators were rated by panelists on a 7-point Likert scale that ranged from “strongly disagree” to “strongly agree”.MethodsA focused literature review was performed to identify candidate indicators. A modified Delphi process, with three rounds, was used to obtain expert consensus on the validity of potential process of care quality indicators.ResultsThirty-three physicians participated (6 from surgery, 10 from critical care, and 17 from nephrology). A list of 58 potential process of care quality indicators for AKI after surgery was generated including 28 indicators from the initial literature review and 30 indicators suggested by panelists. Following the third round of questioning, 40 process of care indicators were identified with a high level of agreement for face validity; 16 of these reached high consensus among all panelists.LimitationsThe consensus of panelists from Alberta, Canada may not be generalizable to other settings. The modified Delphi process did not focus on the feasibility of measuring these process indicators.ConclusionsThese indicators can be used to measure and improve the quality of care for AKI after major surgery.Electronic supplementary materialThe online version of this article (doi:10.1186/s40697-015-0047-8) contains supplementary material, which is available to authorized users.