‘Tackling Acute Kidney Injury’ in Bradford Teaching Hospitals NHS Foundation Trust

Acute Kidney Injury (AKI) is a major cause of harm. 1 in 5 emergency admissions into hospital have AKI and there are delays in recognising AKI which develop in hospitals in around 43% of cases. All patients are at risk but it is known that around 20-30% of AKI cases are avoidable. AKI is estimated to account for 12,000 unnecessary deaths a year. Prevention of 20% of cases would pay salaries and overheads for 20 to 30 extra nurses at every acute Trust.

The Improvement Academy have been supporting Bradford Teaching Hospitals NHS Foundation Trust (BTHFT) to test a package of interventions to improve the recognition, enhance awareness and understanding and improve basic elements in quality of care received by patients with AKI.

With longer term aims to impact on 30 day mortality, incidence of hospital AKI, incidence of AKI progression, length of stay, and proportion of AKI patients with renal recovery by discharge.

BTHFT chose to pilot their care bundle (a set of evidence-based actions that when used together significantly improve patient outcomes) and focused education on one double ward during their three month implementation period. This allowed the team to make timely changes to the process and care bundle with feedback and suggestions from the ward staff before spreading what had worked more widely across the Trust. 

What we found

 

Impact

Testing the interventions in practice taught us some elements of care were happening, but not all. Showing which elements were not done reliably so changes and improvements could be made.

The education programme, when tested taught us that one to one coaching was also sometimes needed, with live cases worked through and case studies developed.

Peer support was crucial, nurses teaching nurses, clinical leadership fellows supporting junior medical staff and key support from senior clinicians.

Next Steps:

"A review meeting at the end of the first three months of AKI interventions at Bradford has been extremely valuable, congratulations to the Bradford team on all of their hard work!" (Nick Selby, Tackling AKI Project lead, Associate Professor of Nephrology & Honorary Consultant Nephrologist)