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Strategy for Uptake of Processes for Recognizing and Responding to Acute Kidney Injury

Not Applicable
Completed
Conditions
Acute Kidney Injury
Interventions
Other: SUPPORT AKI Clinical Decision Support
Registration Number
NCT03564314
Lead Sponsor
University of Calgary
Brief Summary

Acute kidney injury (AKI) is common and costly complication of major surgery. AKI can lead to prolonged hospitalization and a higher likelihood of dialysis, chronic kidney disease and death. However, AKI can be reversed when recognized early, by ensuring that patients receive adequate fluids and medications that worsen kidney function or cause toxicity are avoided or appropriately prescribed. Past research suggests that AKI in surgical settings can be missed early in its onset, leading to delayed intervention and progression to more severe stages. The purpose of this project is to implement clinical decision support for early recognition and management of AKI on surgical units in Alberta hospitals, and to determine whether the initiative leads to improvements in the quality of care for AKI, length of hospital stay for patients, and costs to the healthcare system.

Detailed Description

Overview: Cluster-randomized stepped-wedge trial to evaluate the impact of implementing a clinical decision support initiative for early recognition and management of hospital-acquired AKI.

Study Population: Adult patients hospitalized on surgical units in Alberta who develop acute kidney injury will be eligible if not already receiving dialysis.

Intervention: The multidimensional clinical decision support intervention consists of: (1) electronic and non-computerized tools for early recognition of AKI, (2) educational program for clinical staff, (3) decision support resources and guidance for the management of AKI and consultation with specialists.

Study Design: Using a stepped-wedge design, eight general and vascular surgery unit clusters in Calgary (Foothills Medical Centre, Peter Lougheed Centre) and Edmonton (University of Alberta Hospital, Grey Nuns Community Hospital), Alberta will be randomly ordered to be sequentially introduced to the clinical decision support intervention. The pre-implementation period will include all patients admitted to the participating hospital units in the year before the random timing of introduction of the initiative on each participating unit. The post-implementation study cohort will include patients admitted in the year after the random timing of introduction of the initiative on each unit. Analysis of processes of care and outcomes will focus on patients on these units who develop AKI during the pre- and post-implementation time periods (i.e. are eligible to receive care under the AKI decision support initiative). Additionally, health care providers (e.g. physicians, nursing staff, pharmacists) who have direct experience with the clinical decision support tools and processes will be invited to participate in the surveys and interviews pre- and post-implementation.

Recruitment & Eligibility

Status
COMPLETED
Sex
All
Target Recruitment
2135
Inclusion Criteria
  • Adult patients (18 years of age and older) who develop hospital-acquired acute kidney injury on identified general and vascular surgery units in Alberta
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Exclusion Criteria
  • Hospitalized on non-surgical units
  • Receiving dialysis prior to admission on surgery unit
Read More

Study & Design

Study Type
INTERVENTIONAL
Study Design
SEQUENTIAL
Arm && Interventions
GroupInterventionDescription
SUPPORT AKI Clinical Decision SupportSUPPORT AKI Clinical Decision SupportMultidimensional clinical decision support intervention consisting of education and tools to support early recognition and management of AKI, including guidance on fluid therapies, medication management, investigation, and consultation with specialists.
Primary Outcome Measures
NameTimeMethod
Progression of AKIFrom date of AKI onset to discharge from hospital, assessed up to 30 days

Incidence of progression of AKI to higher AKI stage (including progression to dialysis or death)

Secondary Outcome Measures
NameTimeMethod
Time to initial response to AKIFrom AKI onset up to 48 hours following AKI onset

Time from AKI onset to clinical response with fluid or medication management intervention

MortalityWithin 30 days of AKI onset

All cause mortality

Volume intervention (change in fluid or diuretic order) for AKIWithin 48 hours following AKI onset

New or modified intravenous fluid or diuretic order

Length of AKI hospital stay, daysFrom date of AKI onset to discharge from hospital, assessed up to 30 days

Mean length of hospital stay from acute kidney injury to discharge

Resource use for AKIDuration of index hospital admission, assessed up to 30 days

Mean total health care costs of hospital care during the index admission

Adverse medication exposureWithin 48 hours following AKI onset

Dose modification or suspension or a medication that may cause AKI or that is cleared by the kidney

Medical consultation for AKIWithin 7 days of AKI onset

Consultation with nephrology or general internal medicine

Change in estimated Glomerular Filtration Rate (eGFR)From most recent baseline eGFR measurement prior to AKI onset to eGFR measurement closest to 3 months after AKI onset

The difference in eGFR from baseline to 3 months after development of AKI

Trial Locations

Locations (4)

University of Alberta Hospital

🇨🇦

Edmonton, Alberta, Canada

Grey Nuns Community Hospital

🇨🇦

Edmonton, Alberta, Canada

Peter Lougheed Centre

🇨🇦

Calgary, Alberta, Canada

Foothills Medical Centre

🇨🇦

Calgary, Alberta, Canada

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