Recognition and management of acute kidney injury in hospitalised patients can be partially improved with the use of a care bundle

Joslin, Jennifer; Wilson, Hannah; Zubli, Daniel; Gauge, Nathan; Kinirons, Mark; Hopper, Adrian; Pile, Taryn; Ostermann, Marlies

doi:10.7861/clinmedicine.15-5-431

Cited by 42 publications

(52 citation statements)

References 16 publications

(13 reference statements)

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“…AKI stage 1 was the commonest stage across all ages in this study. The incidence of AKI was higher in the younger age group (∼60% of AKI was in children under 6 years of age) which is similar to other studies (11,21) but contrary to a large epidemiological study by Sutherland et al where the highest incidence of AKI was seen in [15][16][17][18] year olds (10). However, Sutherland et al used ICD-9-CM codes (International Classification of Diseases, Ninth Revision, Clinical Modification) applied at discharge rather than the creatinine-based criteria of AKIN or pRIFLE criteria for diagnosing AKI (10).…”

Section: Discussionsupporting

confidence: 85%

“…The diagnosis of AKI is usually made by identifying increased serum creatinine with or without associated reduced urine output (17). Studies have shown that using a care bundle can improve the recognition of AKI which can lead to early initiation of treatment to reduce progression of AKI and so reduce morbidity and mortality (17,18). The AKI alert algorithm was introduced across NHS England in 2015 to facilitate early diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Full implementation across all NHS England sites was intended by 9th March 2015 but has taken longer and this is often due to individual local hospital issues. Nonetheless, studies in adults have shown the implementation of AKI alerts and using an AKI care bundle improved recognition and management of acute kidney injury in hospitalised patients (17,18).…”

Section: Introductionmentioning

confidence: 99%

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The Incidence of Paediatric Acute Kidney Injury Identified Using an AKI E-Alert Algorithm in Six English Hospitals

et al. 2020

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Objective: Acute kidney injury (AKI) is a significant cause of morbidity and mortality among hospitalised patients. The objectives in this study were (i) to investigate the incidence of AKI using the National Health Services (NHS) AKI e-alert algorithm as a means of identifying AKI; and (ii) in a randomly selected sub-group of children with AKI identified using the algorithm, to evaluate the recognition and management of AKI. Patients and Methods:Retrospective cross-sectional study with initial electronic retrieval of creatinine measurements at six hospitals in England over a six-month period. Results were evaluated using the NHS AKI e-alert algorithm with recognition and management of AKI stages 1, 2 and 3 reviewed in a sub-set of randomly selected patient case notes. Patients aged 29 to 17 years were included. AKI stage 1 was defined as a rise of 1.5 -≤2x baseline creatinine level; AKI stage 2 a rise of ≤ 2.0 and < 3.0; AKI stage 3 a rise of ≥ 3.0. Urine output was not considered for AKI staging.Results: 57,278 creatinine measurements were analysed. 5,325 (10.8%) AKI alerts were noted in 1,112 patients with AKI 1 (62%), AKI 2 (16%) and AKI 3 (22%). There were 222 (20%) <1y, 432 (39%) 1 ≤ 6y, 192 (17%) 6 ≤ 11y, 207 (19%) 11 ≤ 16y, and 59 (5%) 16-17y. Case notes of 123 of 1,112 [11.1%] children with AKI alerts were reviewed. Confirmed AKI was recognised with a documented management plan following its identification in n = 32 [26%] patients only. Conclusions:In this first multicentre study of the incidence of AKI in children admitted to selected hospitals across England, the incidence of AKI was 10.8% with most patients under the age of 6 years and with AKI stage 1. Recognition and management of AKI was seen in just over 25% children. These data highlight the need to improve recognition of AKI in hospitalised children in the UK.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Incidence of Paediatric Acute Kidney Injury Identified Using an AKI E-Alert Algorithm in Six English Hospitals

et al. 2020

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“…Taken together, these results suggest that CBs can potentially improve process of care, although there are some obvious weaknesses in these studies' design: these include the single-centre uncontrolled nature of the comparison groups, the before-after design (which cannot control for independent temporal changes) and the limited scope of data collection that prevents any conclusion about effect on patient outcomes. However, feasibility and sustainability, the latter up to 12 months in the study of Joslin et al [15], are demonstrated.…”

Section: Review Of Current Evidencementioning

confidence: 99%

“…Notably, there was a clear difference between patients who did and did not have a CB completed, with significantly higher standards of care in those who did. In a third study, also of similar design, Joslin et al [15] described a hospital-wide approach to CB introduction, especially because AKI occurs across all acute medical and surgical specialties [16]. Following a baseline audit in all AKI patients over a 1-week period in 2011 (n = 100), a CB was developed and made available via the electronic medical record (EMR); implementation was supported by an improvement team, media launch and an education programme.…”

Section: Review Of Current Evidencementioning

confidence: 99%

Care Bundles for Acute Kidney Injury: Do They Work?

Selby

Kolhe²

2016

Nephron

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Acute kidney injury (AKI) is common and is associated with poor patient outcomes, which in some cases appear associated with deficiencies in the provision of care. Care bundles (CBs) are a structured set of practices designed to improve the processes of care delivery and ultimately patient outcomes, and there have been some demonstrations of their utility in areas such as ventilator-associated pneumonia and in sepsis management. While there is a strong rationale for their use, the evidence base around AKI CBs is small but growing. Here, we review the existing data on the effectiveness of AKI CB and discuss optimal approaches to their future study.

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Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference

et al. 2020

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IMPORTANCE In the last decade, new biomarkers for acute kidney injury (AKI) have been identified and studied in clinical trials. Guidance is needed regarding how best to incorporate them into clinical practice. OBJECTIVE To develop recommendations on AKI biomarkers based on existing data and expert consensus for practicing clinicians and researchers. EVIDENCE REVIEW At the 23rd Acute Disease Quality Initiative meeting, a meeting of 23 international experts in critical care, nephrology, and related specialties, the panel focused on 4 broad areas, as follows: (1) AKI risk assessment; (2) AKI prediction and prevention; (3) AKI diagnosis, etiology, and management; and (4) AKI progression and kidney recovery. A literature search revealed more than 65 000 articles published between 1965 and May 2019. In a modified Delphi process, recommendations and consensus statements were developed based on existing data, with 90% agreement among panel members required for final adoption. Recommendations were graded using the Grading of Recommendations, Assessment, Development and Evaluations system. FINDINGS The panel developed 11 consensus statements for biomarker use and 14 research recommendations. The key suggestions were that a combination of damage and functional biomarkers, along with clinical information, be used to identify high-risk patient groups, improve the diagnostic accuracy of AKI, improve processes of care, and assist the management of AKI. CONCLUSIONS AND RELEVANCE Current evidence from clinical studies supports the use of new biomarkers in prevention and management of AKI. Substantial gaps in knowledge remain, and more research is necessary.

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Recognition and management of acute kidney injury in hospitalised patients can be partially improved with the use of a care bundle

Cited by 42 publications

References 16 publications

The Incidence of Paediatric Acute Kidney Injury Identified Using an AKI E-Alert Algorithm in Six English Hospitals

The Incidence of Paediatric Acute Kidney Injury Identified Using an AKI E-Alert Algorithm in Six English Hospitals

Care Bundles for Acute Kidney Injury: Do They Work?

Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference

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