Acute kidney injury (AKI)

The acute kidney injury (AKI) patient safety collaborative aims to measurably improving timely recognition, treatment and chances of survival for patients with AKI.

AKI is the sudden loss of kidney function. National data suggests that AKI is common in 20% of all emergency admissions to hospitals. AKI is associated with a range of poor outcomes including increased length of stay, the development of chronic kidney disease and death. Many instances of AKI are predictable and preventable.

AKI was identified as one of UCLPartners’ priorities due to the high prevalence of avoidable deaths among hospitalised and often elderly patients. Working with 9 hospitals, we are supporting healthcare professionals to improve the timely recognition of AKI in patients and to respond to their needs with appropriate and safe care to increase the likeliness of survival and reduce the time patients need to spend in hospital.

What are we doing?

We are supporting the work of 9 hospital trusts in improving the care of patients suffering from AKI, by applying the Institute for Healthcare Improvement Breakthrough Series collaborative approach. It provides a robust framework for scaled improvement across a variety of teams and multiple organisations. Teams learn from and inspire each other by sharing and adopting measurable and tested improvements, as well as build improvement capability and patient safety leadership, to become foremost providers of safe and equitable AKI care.

Improvements within the collaborative include changes to patient pathways, sharing of information, updating of systems and review of medication processes.

What have we done so far?

From September 2015 until June 2017 the collaborative has come together for a series of regular AKI learning sessions to share improvements as well as develop quality improvement and measurement skills. During this time the 9 AKI teams totalling 104 people regularly report their AKI process and outcome measures. All reports are currently being collated and findings will be analysed and released later this year.

The aims set-out at the beginning of the collaborative were:

  • To reduce 30-day mortality by 25%
  • To improve recovery of renal function to within 20% of baseline serum creatinine by 25%
  • To improve patient experience and subjective feelings of wellness

The learning sessions were a great platform for showcasing improvements and learning from others. We are pleased to see how much the collaboratives improved. Examples of sustained outcomes and improvements comprise:

  • Up to 90% compliance for AKI door to recognition time (up from 40% baseline)
  • Up to 90% compliance for AKI door to treatment time (up from 71% baseline)
  • 85-90% 30-day survival rate

Implemented changes include:

  • Introduction of real-time alerting systems
  • New and improved AKI pathway from time of presentation to inpatient care and outpatient follow-up
  • Continuous training and education for nurses and doctors, including e-learning
  • New roles for dedicated AKI specialist nurses
  • Implementation of STREAMS app for recognition of patients with AKI
Patient Safety Story Awards 2015-17

We would also like to congratulate the following AKI patient safety teams for winning the Best Patient Safety Storyboard Awards:

  • Winner: Royal Free London NHS Foundation Trust
  • Runner-up: Luton and Dunstable University Hospital NHS Foundation Trust

Read more here.

Collaborative members:
  • 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

Contact us

Thomas Weijburg – Improvement Manager – Patient Safety Programme