Acute Kidney Injury patients benefiting from merger
Clinicians across UHDB have significantly improved the chances of survival for patients with Acute Kidney Injury (AKI).
At Queen’s Hospital Burton, mortality rates for AKI have fallen from 27% to just below 13% in the last 18 months, thanks to the introduction of an AKI care bundle, clinical teams from across UHDB offering support on-site two days a week, and through a dedicated on-call service.
The Renal team at the Trust have been working for the past six years on the care bundle, which highlights when a patient might be suffering from AKI.
This partnership working across UHDB is one of the earliest examples of the benefits being provided to patients following the merger of our two hospital trusts last year.
Dr Nitin Kolhe, Consultant Nephrologist and Clinical Director for Specialist Medicine said: “Since January 2018, we have been working closely to ensure that Consultant Nephrologists are available on-site in Burton twice weekly, as well as providing a dedicated 24/7 on-call service for AKI inpatients to reduce mortality rates, length of stay and progression to the latter stages of AKI. We also use an electronic system that has been set up to alert clinicians about patients displaying signs of AKI, and ensure that they complete the AKI care bundle within 24 hours.”
AKI can occur from a result of dehydration, taking over the counter painkillers and heartburn medications or after complications from another illness, and is sudden damage to the kidneys which prevents them from working properly.
The effects can be as serious as causing complete kidney failure.
The improvements in Acute Kidney Injury started six years ago when the Consultant Nephrologists, which includes Dr Kolhe, researched some of the reasons why patients were progressing to the most serious stages of AKI before anyone was intervening.
Dr Kolhe said: “Patients were progressing to stages 2 and 3 of AKI, when there is little we can do for them other than dialysis. We researched the care of nearly 3,500 patients in Derby and found that if we intervened earlier in their care, they could avoid the later stages of Acute Kidney Injury. A simple blood test to look at creatinine levels to see if these have risen can be an early indicator of Acute Kidney Injury. Then we can give patients fluids to rehydrate them and keep the kidneys healthy. We then worked with IT colleagues to ensure that an alert came up so that clinicians knew to complete the care bundle.”
The care bundle started off in a paper form, but to increase completion by staff, the form has been made available electronically, which has increased completion dramatically, having a knock-on effect on the amount of patients with AKI getting treatment sooner. An interruptive alert is in place in Derby and will soon be implemented in Burton to help to further increase uptake of the care bundle.
Dr Kolhe added that having Consultant Nephrologists on site at Burton was also a contributing factor to the improvements: “We also found from our research of AKI patients that there was a much higher mortality rate when a Nephrologist was not available, and so having members of the Renal team at Burton for two days a week, alongside the implementation of the care bundle and on-going education for the staff have helped to drastically improve patient care.”
There is now a team of 11 Nephrologists working across both Queen’s Hospital and the Royal Derby. Dr Kolhe said that a lot of hard work has gone into improving the service at Queen’s Hospital, but the results show that is has been a worthwhile project. He said: “The team have put so many hours into the AKI care bundle and educating staff about the new system and services and actually began working on this together before the merger even took place. The staff in Burton, including Dr Mukherjee who works with elderly patients who have kidney issues, have received things really well and have worked brilliantly alongside colleagues from Derby to make this happen.”
Karen Wiley, Acutely Recognition Nurse at Queen’s Hospital, said that the added support from the Renal Team since the merger has had a really positive impact on patient outcomes: “I have the support of the wider team now which I previously didn’t have, and we’re able to offer patients better care as a result. The introduction of these changes and the care bundle means that we can treat patients more effectively and more quickly, meaning that they spend less time in hospital and recover faster at home. It also helps patients to develop fewer health complications going forward.”
Dr Magnus Harrison, Executive Medical Director, said: “The renal team across all our hospitals were incredibly pro-active about the merger and started working together nine months before it officially took place. What they have achieved in such a short space of time has been life changing for many patients and demonstrates the benefits of the two hospital trusts coming together. I’m in no doubt that patients across Derbyshire and Staffordshire needing renal care will benefit from the hard work and dedication of this team. I know many of our other clinical services are making similar improvements for our patients.”