Electronic alerting tool to help prevent Acute kidney injury

• Research type

  Research Study

• Full title

  ‘Preventable & Avoidable Acute kidney injury (AKI) should never occur’. The use of an electronic prediction & identification alerting tool to deliver an individualised care bundle for hospital in-patients at risk of, or with confirmed AKI.

• IRAS ID

  126712

• Contact name

  Lui Forni

• Contact email

  lui.forni@wsht.nhs.uk

• Sponsor organisation

  Western Sussex Hospitals NHS Trust

• Duration of Study in the UK

  0 years, 6 months, 1 days

• Research summary

  Acute kidney injury (AKI) is common in hospital in patients with a reported incidence of between 10 – 20% but can be as high as 70% in the critically ill. Even small changes in renal function have been shown to be associated with significant increases in mortality and chronic kidney disease. In 2009, The National Confidential Enquiry into Patient Outcome and Death highlighted that there was unacceptable delay in diagnosing AKI and in at least 20% of cases AKI was thought to be both predictable and avoidable.

  Currently available markers for warning of impending AKI are poor and tend to flag when AKI has already occurred.

  We have developed a simple & practical, robust scoring system utilising physiological measurements, biochemical parameters and known co-morbidities, calculable electronically, that can identify patients at risk of developing AKI following hospital admission. Furthermore we have developed this into an automated electronic AKI prediction & identification tool utilising the hospital Patient Administration System (PAS), pathology database & Patientrack physiological Early Warning System to deliver near real-time alerts to nursing & medical staff. The alert can trigger an automated e-mail to the patient’s consultant & will advise on a care bundle which can be individualised for the patient.

  We will investigate across two hospital sites whether the introduction of this alerting system can help to reduce avoidable harm related to kidney injury.

  We will externally validate the scoring system and then with an alert aim to reduce:
  1. The incidence of AKI in those patients ‘at risk’
  2. The harm (mortality, morbidity, length of stay) associated with failure to recognise patients with AKI.

  Outcomes will include:
  • Incidence of AKI
  • Magnitude of acute deterioration in Creatinine, eGFR
  • Mortality
  • Morbidity – secondary complications including other organ failures
  • Length of stay
  • Requirement for renal replacement therapies
  • Requirement for escalation to critical care

  There are potential significant health benefits to this study and a cost-benefit analysis will also be performed.

• REC name

  London - Bromley Research Ethics Committee

• REC reference

  13/LO/0960

• Date of REC Opinion

  24 Jul 2013

• REC opinion

  Favourable Opinion