Team-Based Coaching Intervention to Improve Contrast-Associated Acute Kidney Injury

Abstract

Visual Abstract

Factors Shaping the Implementation of Strategies to Prevent Acute Kidney Injury: A Qualitative Study

“…Unfortunately, despite the importance of reducing AKI, widely accepted prevention methods are inconsistently applied across practice settings (Elicker et al, 2006). To address this need, the IMPROVE-AKI study was a 2 × 2 factorial cluster-randomized trial testing the impact of implementation strategies on adoption of AKI prevention methods and clinical outcomes in 19 cardiac catheterization laboratories in Veterans Administration (VA) Medical Centers (Brown et al, 2023). The VA setting was chosen because this provided a national synchronized common data model, common electronic health record and technology infrastructure, as well as common resources.…”

“…As such, the VA setting was chosen as a national network of hospitals with a common data model to support the automated surveillance dashboard. Methods describing the common data model and the automated surveillance dashboard as an intervention in this setting have been previously described (Brown et al, 2023). Sites in the IMPROVE-AKI study aimed to reduce contrast-associated AKI using a common set of prevention strategies in an AKI preventive toolkit designed by the study team.…”

Can Quality Improvement Reduce the Risk of Contrast-Associated Acute Kidney Injury?

“…In this issue of CJASN , Brown et al 11 expand on these earlier QI implementation studies addressing CA-AKI by conducting the IMPROVE AKI trial. IMPROVE AKI is a hybrid type 1 effectiveness implementation trial that uses a 2×2 factorial prospective cluster-randomized design.…”

“…9 For other hospitals or practices, it may be worthwhile to collect data on their CA-AKI incidence, and if the results are similar or above currently reported averages or benchmarks, then these institutions may benefit from a QI initiative similar to that described by Brown et al . 11 Interested physicians need to understand that local QI expertise, development of a structured plan on the basis of evidence-based standards, the presence of clinical champions, and physician and institutional engagement are all pre-requisites for successful implementation of QI initiatives. Institutional resources are needed to protect the time of physicians, nurses, and technicians to allow participation in the QI process.…”