Matthew T James1, Bryan J Har2, Ben D Tyrrell3, Bryan Ma4, Peter Faris5, Tolulope T Sajobi6, David W Allen7, John A Spertus8, Stephen B Wilton9, Neesh Pannu10, Scott W Klarenbach10, Michelle M Graham11. 1. Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: mjames@ucalgary.ca. 2. Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 3. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; CK Hui Heart Centre, University of Alberta, Edmonton, Alberta, Canada. 4. Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 5. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada. 6. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 7. Department of Cardiac Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. 8. Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA. 9. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 10. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. 11. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Heart Centre, University of Alberta, Edmonton, Alberta, Canada.
Abstract
BACKGROUND: Contrast-induced acute kidney injury (CI-AKI) is a common and serious complication of invasive cardiac procedures. Quality improvement programs have been associated with a lower incidence of CI-AKI over time, but there is a lack of high-quality evidence on clinical decision support for prevention of CI-AKI and its impact on processes of care and clinical outcomes. METHODS: The Contrast-Reducing Injury Sustained by Kidneys (Contrast RISK) study will implement an evidence-based multifaceted intervention designed to reduce the incidence of CI-AKI, encompassing automated identification of patients at increased risk for CI-AKI, point-of-care information on safe contrast volume targets, personalized recommendations for hemodynamic optimization of intravenous fluids, and follow-up information for patients at risk. Implementation will use cardiologist academic detailing, computerized clinical decision support, and audit and feedback. All 31 physicians practicing in all 3 of Alberta's cardiac catheterization laboratories will participate using a cluster-randomized stepped-wedge design. The order in which they are introduced to this intervention will be randomized within 8 clusters. The primary outcome is CI-AKI incidence, with secondary outcomes of CI-AKI avoidance strategies and downstream adverse major kidney and cardiovascular events. An economic evaluation will accompany the main trial. CONCLUSIONS: The Contrast RISK study leverages information technology systems to identify patient risk combined with evidence-based protocols, audit, and feedback to reduce CI-AKI in cardiac catheterization laboratories across Alberta. If effective, this intervention can be broadly scaled and sustained to improve the safety of cardiac catheterization.
BACKGROUND: Contrast-induced acute kidney injury (CI-AKI) is a common and serious complication of invasive cardiac procedures. Quality improvement programs have been associated with a lower incidence of CI-AKI over time, but there is a lack of high-quality evidence on clinical decision support for prevention of CI-AKI and its impact on processes of care and clinical outcomes. METHODS: The Contrast-Reducing Injury Sustained by Kidneys (Contrast RISK) study will implement an evidence-based multifaceted intervention designed to reduce the incidence of CI-AKI, encompassing automated identification of patients at increased risk for CI-AKI, point-of-care information on safe contrast volume targets, personalized recommendations for hemodynamic optimization of intravenous fluids, and follow-up information for patients at risk. Implementation will use cardiologist academic detailing, computerized clinical decision support, and audit and feedback. All 31 physicians practicing in all 3 of Alberta's cardiac catheterization laboratories will participate using a cluster-randomized stepped-wedge design. The order in which they are introduced to this intervention will be randomized within 8 clusters. The primary outcome is CI-AKI incidence, with secondary outcomes of CI-AKI avoidance strategies and downstream adverse major kidney and cardiovascular events. An economic evaluation will accompany the main trial. CONCLUSIONS: The Contrast RISK study leverages information technology systems to identify patient risk combined with evidence-based protocols, audit, and feedback to reduce CI-AKI in cardiac catheterization laboratories across Alberta. If effective, this intervention can be broadly scaled and sustained to improve the safety of cardiac catheterization.
Authors: Matthew T James; Bryan J Har; Benjamin D Tyrrell; Peter D Faris; Zhi Tan; John A Spertus; Stephen B Wilton; William A Ghali; Merril L Knudtson; Tolulope T Sajobi; Neesh I Pannu; Scott W Klarenbach; Michelle M Graham Journal: JAMA Date: 2022-09-06 Impact factor: 157.335
Authors: Jennifer Natha; Pantea Amin Javaheri; Denise Kruger; Eleanor Benterud; Winnie Pearson; Zhi Tan; Bryan Ma; Ben D Tyrrell; Bryan J Har; Michelle M Graham; Matthew T James Journal: CJC Open Date: 2020-11-12
Authors: Bryan Ma; Peter Faris; Bryan J Har; Ben Tyrrell; Eleanor Benterud; John A Spertus; Neesh Pannu; Braden J Manns; Michelle M Graham; Matthew T James Journal: CJC Open Date: 2021-10-23
Authors: Linh N Bui; Cassondra Marshall; Chris Miller-Rosales; Hector P Rodriguez Journal: Qual Manag Health Care Date: 2022 Apr-Jun 01 Impact factor: 0.926