ESTABLISHMENT OF A MULTI-FACETED ACUTE KIDNEY INJURY (AKI) SERVICE INVOLVING AN AKI E-ALERT SYSTEM AND CARE BUNDLE
Sophy Fan1, Sven Jean Tan Emily See1, Jade Ryan1, Tim Fazio1, Anna Bendall1, Nigel Toussaint1 1Department of Nephrology, The Royal Melbourne Hospital, Parkville, VIC, Australia
Abstract
Aim
To assess benefits of implementing an acute kidney injury (AKI) service at a quaternary hospital involving an AKI e-alert system and care bundle.
Background
There is an increasing incidence of AKI with significant short- and long-term impacts on patients and the healthcare system. Internationally, AKI electronic alerts (‘e-alerts’) have been reported to increase detection of AKI and improve patient and healthcare outcomes, especially when used in conjunction with multi-faceted AKI ‘care bundles’. AKI e-alerts/care bundles can potentially reduce time to AKI recovery and decrease hospital length of stay (LOS), need for kidney replacement therapy (KRT) and overall patient morbidity and mortality, but implementation has not been reported in Australia.
Methods
We established a multi-faceted AKI service utilising our hospital electronic medical record (EMR) (12-month pilot project, 1/04/2022-31/03/2023). The AKI service involved an (i) e-alert system to identify AKI in multiday admission patients (>24hrs) under any surgical unit, and (ii) AKI bundle (in EMR) to allow self-referral and communication of management. We also conducted AKI education programs for surgical unit medical/nursing staff.
Results
Of 12,744 multiday hospital admissions in the 12-month study period (n=12,138 patients), 5,034 (39.5%) involved surgical admissions. 507 surgical admissions (10.1%) were complicated by AKI (stages 1,2 and 3– 7.7%,1.0%,1.3% respectively). Rates of surgical admissions with AKI involving ICU (44.2% compared to baseline 49%) and CCU (2.1 vs 3.4%), those requiring KRT (1.9 vs 3.9%), median hospital LOS (13.4 vs 17.1 days) and inpatient mortality (6.7 vs 8.6%) were less than our published 2018/2019 baseline data.
Conclusion
Our AKI pilot project reports a successful program improving hospital patient flow, early AKI detection and management and overall outcomes of surgical patients with AKI.