Acute kidney injury (AKI)

How was AKI identified as a UCLPartners patient safety programme workstream?

In mid-2014 UCLPartners consulted its partner organisations through medical directors, nursing directors, executive forums and discussions with clinicians. Face-to-face consultation was supported by a formal survey. Acute kidney injury (AKI) and sepsis were identified as priority areas for partners as well as being responsible for the greatest number of avoidable deaths (based on national data). These form the first two workstreams of the UCLPartners patient safety programme.

What is AKI?

AKI is an abrupt deterioration in renal function. AKI is caused by a number of acute triggers including sepsis, hypovolaemia, toxicity (from drugs and radiological contrast), urological obstruction and primary renal disease (such as nephritis).

AKI is common in hospitalised patients; published data suggests that it occurs in up to 20% of acute admissions, is particularly prevalent in the elderly and its incidence is increasing. AKI is associated with a range of poor outcomes including increased length of stay, the development of chronic kidney disease and death. Furthermore, many instances of AKI are predictable and preventable.

  • In England, the number of excess deaths associated with AKI has been estimated to be 40,000 per annum – a mortality burden greater than that due to late diagnosis of cancer and venous thromboembolism (the most common form being deep vein thrombosis (DVT)) combined.
  • AKI-associated healthcare costs in England are estimated at more than £1bn per annum- greater than those attributable to breast cancer.
  • The 2009 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) into the care of patients with AKI found that roughly 20% of cases of in-hospital AKI were preventable, and that the care of patients with established AKI was “good” less than half the time. Shortcomings in care across pathways were noted including problems with early therapy, escalation and access to specialist services.

What is the aim of the UCLPartners AKI workstream?

The aim is to improve identification and treatment of AKI across our participating trusts, thereby improving patient outcomes and care. In its initial stages the workstream will address the early secondary care AKI pathway focusing on quality improvement (QI) capability and patient safety leadership to create leaders of AKI care in the region.

Who is the clinical lead?

CL small

Dr Chris Laing, Consultant Nephrologist and Associate Medical Director, Royal Free London NHS Foundation Trust

Chris is a Consultant Nephrologist and Associate Medical Director for patient safety at Royal Free London NHS Foundation Trust. In the latter role he is clinical lead for a large cross-trust improvement programme. His principal interests are acute kidney injury and patient safety. He has previously been a specialist advisor to National Confidential Enquiry into Patient Outcome and Death (NCEPOD) AKI, guideline development group member for NICE AKI and is a board member of the “Think Kidneys” National AKI programme. He is renal lead for the large, multi-centre ERICCA trial which has examined ischaemic preconditioning in cardiac surgery patients. He co-founded the AKI Academy and is chair for the London AKI Network (Renal Strategic Clinical Network).

Methodology

Our approach is based on the Breakthrough Series Collaborative Framework developed by The Institute for Healthcare Improvement (IHI). This is a specific, time-limited improvement methodology that has been deployed in around 1000 projects worldwide, designed to speed up the adoption of accepted best practice or evidence. This framework approach is summarised below. We held our third successful Learning Session on 17 June 2016. We are currently in Action Period 3, and we are looking forward to seeing you all at our measurement day on 23 September 2016.

Action period diagram

Which Trusts have expressed an interest?

We were delighted to have nine trusts participating:

  • Barking, Havering and Redbridge University Hospitals NHS Trust
  • Barts Health NHS Trust
  • Basildon and Thurrock University Hospitals NHS Foundation Trust
  • Homerton University Hospital NHS Foundation Trust
  • Luton and Dunstable University Hospital NHS Foundation Trust
  • Princess Alexandra Hospital NHS Trust
  • Royal Free London NHS Foundation Trust
  • Southend University Hospital NHS Foundation Trust
  • University College London Hospitals NHS Foundation Trust

Current activities and next steps

Trust teams are currently working on establishing and improving measurement, and trialling small tests of change using PDSA cycles to improve processes within their AKI pathway using the IHI Model of Improvement.

We are meeting with the teams during their patient safety operational meetings to support their local QI projects as well as to determine any other support they may require. We have commenced our lunchtime webinars and have created a collaborative zone to support trusts throughout the development of their QI projects. QI templates, the Collaborative Framework, change package and driver diagram can all be downloaded in the Collaborative Zone.

After three successful Learning Sessions, we are now in Action Period 3 and planning for a great end of year summit on Friday 2 December 2016.

Stay up to date on our work! Subscribe to our quarterly newsletter or follow us follow us @UCLPartnersPSP

Feel free to contact a member of the team if you have any questions or feedback