This is how we can improve mortality for hospital inpatients with acute kidney injury.
As a non-nephrologist participating in general medical on-call, I am very much aware of the prevalence of acute kidney injury (AKI) in acute medical admissions. AKI in these patients is associated with over a 6-fold increase in mortality and an average 3.5-day increase in hospital stay. In a systemic analysis in the UK by the National Confidential Enquiry into Patient Outcomes and Death, they found that only 50% of hospital inpatients with AKI received ‘good care’. Dr Chandrasekar et al. report on their systems analysis of reasons why patients with AKI were not optimally managed within their healthcare organization. They then put together, an AKI intervention bundle incorporating a small number of evidence-based interventions. They combined this with a staff/ patient education programme and subsequent support by an outreach clinical support team, which provided an earlier alert of AKI and support for the management of these patients. The consequence of these efforts was a 22% reduction in mortality from AKI and a 2.6-day reduction in length of stay over the 33-month study period. The authors are to be commended for their highly significant efforts in improving the care for their patients. Their systems analysis approach and self-reflection evaluation allowed for the development of a specific simplified AKI intervention bundle combined with an early alert process and clinical support which delivered impressive results. This is a model that we should all study closely with regard to its potential adoption within our own healthcare region.