Tackling acute kidney injury: a multi-centre quality improvement project Derby Hospitals NHS Foundation Trust

In England, over half a million people sustain an acute kidney injury (AKI) every year and it is estimated to cost the NHS in England £1 billion. It is a harmful but often preventable condition, and there is evidence that care processes can be improved to provide better outcomes.

This project, led by Derby Hospitals NHS Foundation Trust, targeted deficiencies in care for this group of patients. 

A promising intervention had already been introduced at the Royal Derby Hospital, and was associated with improved patient outcomes. This project involved scaling up the initiative across two hospital networks, to test its scalability and impact.

The TAKI intervention had three components: an education package to improve understanding and awareness of AKI; a standardised algorithm embedded in hospital laboratories to detect AKI and generate electronic alerts for AKI; and a care bundle to reduce variation in the management of patients with AKI. 

The intervention was successfully rolled out across five hospitals within a stepped-wedge cluster randomised study design: Leeds General Infirmary, Leeds St James’ Hospital, Bradford Royal Infirmary, Ashford and St Peter’s Hospital, and Frimley Park Hospital. Its effects were studied in over 24,000 cases of AKI. 

Introduction of the intervention led to an improvement in most audited processes of AKI care, though from different baselines and to different extents in the different hospitals. Although the intervention did not alter 30-day mortality rates, it was associated with reductions in length of hospital stay (LoS), shorter duration of AKI episodes, and an increase in AKI incidence that likely reflected improved recognition. 

The impact on LoS and AKI duration was seen in those people with longer admissions or longer AKI duration.