The Acute Kidney Injury Impact and Learning report provides a summary of the progress and learning from the Acute Kidney Injury (AKI) Collaborative which was launched in August 2017 and completed in March 2019.
It also provides recommendations for the next steps for this work.
The impact of the collaborative has been in the following areas:
1. Implementation of the AKI algorithm and e-alerts
An episode of AKI is detected in routine blood tests by monitoring changes in an individual’s kidney function. When the AKI algorithm is integrated into the laboratory system it will identify potential cases of AKI in real time and produce a flagged test result as an e-alert. All NHS boards within the collaborative have activated e-alerts as a critical step to improving recognition and response for people with AKI. The data produced from the algorithm has helped teams recognise and better understand areas of high incidence of AKI, identify priority areas for improvement activity and measure the impact of changes.
2. Education and raising awareness of AKI
Through a variety of different approaches with both staff and the public, this has been key to improving knowledge of AKI risk, important steps that can be taken to prevent AKI and drive engagement in improvement activity.
3. Changes to care processes
Through tests of change, care processes were a focus of improvement. For example, an improvement approach was undertaken in one NHS board to develop a structured process to standardise communication and response for a patient with an AKI.
A number of learning points have emerged which will inform the next steps for work on reducing harm from AKI.
The main points are:
- the set-up of the collaborative, including the process for recruitment of teams, the
importance of local improvement support and the process to ensure a shared
understanding of expectations for participants
- the method for delivery and whether or not there were better models to support
prototyping work to meet the needs of this collaborative
- to what extent the collaborative content reflected the needs of the participants
- the importance of AKI e-alerts to recognise AKI early
- the need for a process to communicate an AKI e-alert so that clinical staff can take the appropriate action to prevent further progression
- the complexity of the response to AKI, and
- the role of education and raising awareness of an AKI to support sustainable improvement.
The next stage of this work will build on the learning and successes from this collaborative. This will help to develop future approaches for reducing harm from AKI.
SPSP will use the learning to:
- revise the driver diagram, change package and measurement plan
- offer continued support to the participating NHS boards
- enter into a partnership agreement with a clear expectation on reporting of outcome data
- facilitate networking events, and
- explore opportunities to align AKI collaborative with the SPSP deteriorating patient workstream.