SO016SPREAD OF ACUTE KIDNEY INJURY IMPROVEMENT PROGAMME ACROSS A LARGE MULTI SITED NHS HOSPITAL
Authors: Hanumapura Prasanna , Ebah Leonard , Waring Deryn , Henney Robert , Murphy Michelle , Challiner Rachael , Halligan Siobhan , Hayden Katherine , O'Toole Charlotte 
Published: June 2020

Abstract

Background and Aims
Acute kidney injury (AKI) is a widely recognised serious health care issue. Up to 25% of hospital patients can develop it, with worse outcomes compared non AKI. A UK–wide audit in 2009 and our local audit in 2014 showed consistently poor AKI care including delays in detection and inconsistent management of cases. The trust set up the AKI Team in 2014 to improve AKI detection, care and outcomes.
Successful implementation of a Multifaceted Quality Improvement (QI) Programme for AKI across the main hospital campus since 2015 saw significant improvement in AKI care and outcomes; recognition within 24hrs improved from 52% to 100% since 2016; there has been a 34% reduction in AKI incidence, 26% reduction in AKI length of stay (LoS) ,42% reduction in AKI days (time to recovery) and 10% less AKI associated mortality.
The Trust being one of the largest acute trusts in the UK (10 hospitals across 6 sites, over 2000 beds), the QI spread represented a formidable challenge.
We describe the methodology and outcomes of AKI QI spread across the trust.

Method

Central Campus Hospitals
Improvement on this site involved setting a bespoke electronic alert coupled with education, key stake holder engagement, gradual culture change and AKI Priority Care Checklist (PCC) and use of change agent (AKI Clinical Nurse Specialist-CNS) visiting local teams and empowering them to manage AKI using Demming’s Model for Improvement
A stepwise staggered similar approach was implemented first in the Women’s and Eye Hospitals followed by Children’s Hospital after a local adaptation and testing of algorithm, PCC and appointment of local change agent, a Paediatric AKI CNS.

West Campus Hospital
A DGH with 230 beds, 1-2 incident cases of AKI/day required a bespoke approach. The central AKI team runs an AKI alerts report and remotely alert the local multidisciplinary teams and empowering them to implement the PCC.

South Campus Hospitals
A large tertiary hospital merged in 2018 with an existing AKI CNS team. Detection algorithms, education material, PCC, reporting, and approach have been progressively harmonized using the Central Campus model.
Data is expressed using SPC charts and analysed by t-test.

Results
Care process and outcome measures have seen a consistent improvement across all sites. As reported in the Central Campus, recognition of AKI within 24hrs has improved from 52% to 100% since 2016; there has been a 34% reduction in AKI incidence (p&lt;0.00001), 26% reduction in AKI LoS and a 42% reduction in AKI days (time to recovery).
The Children’s Hospital had 24% reduction (p&lt;0.0001) in AKI incidence and a 34% reduction in hospital acquired AKI. Recognition of AKI has improved from 42% to 100%; 15% reduction in AKI LoS and 22% reduction in AKI days.
In the South Campus recognition of AKI has improved from 67% to 100% and 19% reduction (p&lt;0.0015) in AKI incidence. LoS and AKI days data yet to be reported whilst IT systems are been harmonised.
In West Campus recognition is 100% but the small numbers prevent any meaningful analysis of other outcomes.

Conclusion
This study demonstrates how a cluster of simple interventions and approach to AKI detection and care were successfully rolled out across a multisite large complex acute care organization taking into account the local realities of each site/Hospitals whilst maintaining the core interventions.