Acute Kidney Outreach to Reduce Deterioration and Death (AKORDD) - A Pilot Study to Look at Enhancing Patient Care, Improving Patient Outcomes and Reducing NHS Costs
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 1,865
- 试验地点
- 1
- 主要终点
- Composite measure of participants not alive, need for dialysis, or progression of AKI stage
研究概览
简要总结
The study pilots an outreach service for Acute kidney injury (AKI) patients, based on electronic alerts. Using the alerts we will contact the primary clinician caring for the patient with AKI in the Intervention group. The study has a control group of patients receiving good standard care, but without Outreach. The aim is to reduce morbidity and mortality in the syndrome, and also to reduce healthcare costs.
详细描述
Lay summary:
About one in six hospital inpatients suffer Acute Kidney Injury (AKI), also called acute renal failure. About a third of patients with AKI die. The large majority of patients with AKI are managed by doctors who are not kidney experts. Effective AKI advice and treatments are available but not currently integrated into routine care. A recent National review of the care of patients who died from AKI showed poor management of many patients. Early diagnosis of AKI can avoid complications, dialysis (which affects the quality of life of patients, and is costly) or death. AKI is diagnosed by a change in a blood test. We have developed computer software to diagnose AKI earlier. It sends a warning or 'Alert' about the test to our team of kidney experts. We will further develop the settings of the Alert system. It needs to send an Alert for the right patients. We will also study the best way to make clinicians pay attention to their patients who are developing AKI. When our expert Outreach team receive an Alert, they will call the doctor or nurse looking after the patient with AKI. We will advise on the best treatment for that patient, to reduce their risk of death, dialysis and other complications. We will do a pilot study in one large hospital, to further develop the system, and check it reduces the risk of death or complications from AKI. We will use this work to develop a larger trial of this new system of care for patients with AKI in different hospitals. This will convince the wider NHS of the need to change, and show how to prevent or reduce AKI. Ultimately we aim to improve patients' lives by reducing avoidable death and illness from AKI , and also save the NHS money.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •adult patients with an Alert for AKI issued in accordance with the national algorithm for AKI alerts (NHS England)
- •AKI stage 2 or 3 (this criterion is under review during the preparatory phase of the study)
排除标准
- •patients already on dialysis for AKI at the time of alert
- •patients with End stage renal disease
- •patients <18 years of age
- •patients with no evidence of AKI on review of the automated Alert
- •patients dissenting from participation according to the Ethics application
研究组 & 干预措施
After study Intervention arm Heartlands
The trial has 4 arms in a Before and After design:
Arm 3. After/Heartlands area patients receiving the experimental intervention
Patients who have AKI and are either inpatients in the Intervention hospital or living within the surrounding catchment area are eligible. The intervention will be in the form of a telephone call to the primary clinician or visit to the patient. The intervention will include:
Rapid diagnosis of AKI cause; Rapid treatment of AKI cause; Stopping 'nephrotoxic' drugs; Early nephrology followup for stage 3 AKI survivors; and preventing recurrent AKI.
干预措施: Rapid diagnosis of AKI cause (Other)
After study Intervention arm Heartlands
The trial has 4 arms in a Before and After design:
Arm 3. After/Heartlands area patients receiving the experimental intervention
Patients who have AKI and are either inpatients in the Intervention hospital or living within the surrounding catchment area are eligible. The intervention will be in the form of a telephone call to the primary clinician or visit to the patient. The intervention will include:
Rapid diagnosis of AKI cause; Rapid treatment of AKI cause; Stopping 'nephrotoxic' drugs; Early nephrology followup for stage 3 AKI survivors; and preventing recurrent AKI.
干预措施: Rapid treatment of AKI cause (Other)
After study Intervention arm Heartlands
The trial has 4 arms in a Before and After design:
Arm 3. After/Heartlands area patients receiving the experimental intervention
Patients who have AKI and are either inpatients in the Intervention hospital or living within the surrounding catchment area are eligible. The intervention will be in the form of a telephone call to the primary clinician or visit to the patient. The intervention will include:
Rapid diagnosis of AKI cause; Rapid treatment of AKI cause; Stopping 'nephrotoxic' drugs; Early nephrology followup for stage 3 AKI survivors; and preventing recurrent AKI.
干预措施: Stopping 'nephrotoxic' drugs (Other)
After study Intervention arm Heartlands
The trial has 4 arms in a Before and After design:
Arm 3. After/Heartlands area patients receiving the experimental intervention
Patients who have AKI and are either inpatients in the Intervention hospital or living within the surrounding catchment area are eligible. The intervention will be in the form of a telephone call to the primary clinician or visit to the patient. The intervention will include:
Rapid diagnosis of AKI cause; Rapid treatment of AKI cause; Stopping 'nephrotoxic' drugs; Early nephrology followup for stage 3 AKI survivors; and preventing recurrent AKI.
干预措施: Early nephrology followup for stage 3 AKI (Other)
After study Intervention arm Heartlands
The trial has 4 arms in a Before and After design:
Arm 3. After/Heartlands area patients receiving the experimental intervention
Patients who have AKI and are either inpatients in the Intervention hospital or living within the surrounding catchment area are eligible. The intervention will be in the form of a telephone call to the primary clinician or visit to the patient. The intervention will include:
Rapid diagnosis of AKI cause; Rapid treatment of AKI cause; Stopping 'nephrotoxic' drugs; Early nephrology followup for stage 3 AKI survivors; and preventing recurrent AKI.
干预措施: Preventing recurrent AKI (Other)
After study Intervention arm Heartlands
The trial has 4 arms in a Before and After design:
Arm 3. After/Heartlands area patients receiving the experimental intervention
Patients who have AKI and are either inpatients in the Intervention hospital or living within the surrounding catchment area are eligible. The intervention will be in the form of a telephone call to the primary clinician or visit to the patient. The intervention will include:
Rapid diagnosis of AKI cause; Rapid treatment of AKI cause; Stopping 'nephrotoxic' drugs; Early nephrology followup for stage 3 AKI survivors; and preventing recurrent AKI.
干预措施: Good standard care (Other)
After study Control arm Good Hope
The trial has 4 arms in a Before and After design:
Arm 4. After/Good Hope area patients observed whilst receiving active comparator
Patients who have AKI, as shown by having an Alert for such, and are either inpatients in Good Hope Hospital or living within the surrounding catchment area. These patients will receive good standard care (active comparator), but none of the interventions listed for the Intervention group.
干预措施: Good standard care (Other)
Before study Heartlands area
The trial has 4 arms in a Before and After design:
Arm 1. Before/Heartlands area patients observed whilst receiving active comparator
Patients who have AKI, as shown by having an Alert for such, and are either inpatients in Heartlands Hospital or living within the surrounding catchment area. These patients will receive good standard care (active comparator), but none of the interventions listed for the Intervention group.
干预措施: Good standard care (Other)
Before study Good Hope area
The trial has 4 arms in a Before and After design:
Arm 2. Before/Good Hope area patients observed whilst receiving active comparator
Patients who have AKI, as shown by having an Alert for such, and are either inpatients in Good Hope Hospital or living within the surrounding catchment area. These patients will receive good standard care (active comparator), but none of the interventions listed for the Intervention group.
干预措施: Good standard care (Other)
结局指标
主要结局
Composite measure of participants not alive, need for dialysis, or progression of AKI stage
时间窗: within 30 days
Combined endpoint
次要结局
未报告次要终点