Amrita Ramnarine
Redbridge University Hospitals Trust
Title: Implementation of a dedicated nurse-led AKI Service in a District General Hospital, a Retrospective Audit
Biography
Biography: Amrita Ramnarine
Abstract
Introduction:
Acute Kidney Injury (AKI) is a prevalent clinical feature in the secondary care setting, the severity of which is correlated with mortality. The NCEPOD AKI Audit 2009 identified substandard management of AKI across NHS England despite the availability of clinical guidelines (e.g. KDIGO) and protocol driven measures such as 'AKI care bundles'. Barking, Havering and Redbridge University Hospitals Trust (BHRUT) present an audit examining the efficacy of a dedicated ‘AKI Nurse' service employing a systematic approach to oversee management of patients with AKI across the medical and surgical specialities.
Method:
Baseline data were retrospectively obtained from patients admitted to BHRUT identified as AKI-3 as defined by the KDIGO criteria from 2015-17 (n=389).
Outcomes of interest:
- Length of hospital stay
- Mortality during hospital stay
Patients with CKD4 and 5 or on dialysis were excluded.
Intervention:
Patients with AKI-3 were identified to the AKI Nurse by the laboratory software prompting clinical review, ensuring implementation of the trust’s AKI care bundle and promoting appropriate consultant review. After implementation, further patient data meeting the same inclusion/exclusion criteria were collected for a period of 12 months (n=303).
Results and Conclusion:
Initial analysis demonstrates a reduction of inpatient mortality post intervention (32.3% Vs 48%). A small expected increase inpatient stay was identified in those who did not suffer inpatient mortality (13 days Vs 18 days). Additionally, the mean length of stay for all patients was again expectedly increased (18.6d vs 12d). These initial findings suggest an improvement in patient outcomes with the input of a dedicated AKI Nurse service.