Mark E Thomas1, Alice Sitch2, Jyoti Baharani1, George Dowswell3. 1. Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK. 2. Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham B15 2TT, UK. 3. Department of Primary Care Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK.
Abstract
BACKGROUND: There have been few studies of earlier systematic intervention to reduce the impact of acute kidney injury (AKI). In 2009, we piloted an AKI outreach service with a before and after study, and we report on the study and its longer-term follow-up. METHODS: AKI patients were identified using a laboratory delta check for creatinine of 75%. In the 4-week before phase patients received standard care. In a consecutive 7-week after phase an outreach team of nephrology doctors and nurses reviewed all alerts twice daily, 5 days a week. The primary clinical team caring for the patient was called to be given advice on AKI care. RESULTS: There were 157 and 251 patients in the before and after groups, respectively, who were comparable in their characteristics. The mean age was 70 years in both groups and ∼ 80% of each group were admitted to the hospital. In the after group, the Outreach telephone call was successful in 88%, at a median of 14 h. Substantial numbers of recommendations were made, largely related to fluid balance, investigations and medication use. Survival showed an immediate non-significant improvement in the after group, but converged at about 4 years. CONCLUSION: Outreach shows potential to improve outcomes in AKI. In order to achieve this it seems likely that at least a five-day per week service will be needed to assist good renal and general medical care for this vulnerable group.
BACKGROUND: There have been few studies of earlier systematic intervention to reduce the impact of acute kidney injury (AKI). In 2009, we piloted an AKI outreach service with a before and after study, and we report on the study and its longer-term follow-up. METHODS: AKI patients were identified using a laboratory delta check for creatinine of 75%. In the 4-week before phase patients received standard care. In a consecutive 7-week after phase an outreach team of nephrology doctors and nurses reviewed all alerts twice daily, 5 days a week. The primary clinical team caring for the patient was called to be given advice on AKI care. RESULTS: There were 157 and 251 patients in the before and after groups, respectively, who were comparable in their characteristics. The mean age was 70 years in both groups and ∼ 80% of each group were admitted to the hospital. In the after group, the Outreach telephone call was successful in 88%, at a median of 14 h. Substantial numbers of recommendations were made, largely related to fluid balance, investigations and medication use. Survival showed an immediate non-significant improvement in the after group, but converged at about 4 years. CONCLUSION: Outreach shows potential to improve outcomes in AKI. In order to achieve this it seems likely that at least a five-day per week service will be needed to assist good renal and general medical care for this vulnerable group.
Authors: Philippe Lachance; Pierre-Marc Villeneuve; Oleksa G Rewa; Francis P Wilson; Nicholas M Selby; Robin M Featherstone; Sean M Bagshaw Journal: Nephrol Dial Transplant Date: 2017-02-01 Impact factor: 5.992
Authors: Michael Haase; Andreas Kribben; Walter Zidek; Jürgen Floege; Christian Albert; Berend Isermann; Bernt-Peter Robra; Anja Haase-Fielitz Journal: Dtsch Arztebl Int Date: 2017-01-09 Impact factor: 5.594
Authors: Sidney Le; Angier Allen; Jacob Calvert; Paul M Palevsky; Gregory Braden; Sharad Patel; Emily Pellegrini; Abigail Green-Saxena; Jana Hoffman; Ritankar Das Journal: Kidney Int Rep Date: 2021-02-26
Authors: Philippe Lachance; Pierre-Marc Villeneuve; Francis P Wilson; Nicholas M Selby; Robin Featherstone; Oleksa Rewa; Sean M Bagshaw Journal: BMJ Open Date: 2016-05-05 Impact factor: 2.692
Authors: Eric A J Hoste; Kianoush Kashani; Noel Gibney; F Perry Wilson; Claudio Ronco; Stuart L Goldstein; John A Kellum; Sean M Bagshaw Journal: Can J Kidney Health Dis Date: 2016-02-26