Why a culture change is needed alongside real-time data analysis with acute kidney injury

We were very proud to have been shortlisted for our work on improving the detection and management of acute kidney injury (AKI) with South Tees Hospital NHS Foundation Trust at this year’s Bright Ideas in Health Awards. The initiative was also highly commended at this year’s HSJ awards for patient safety.


Acute kidney injury has been a hidden challenge for healthcare service, in the UK and worldwide. It commonly complicates acute illness and independently worsens patient outcomes. Despite its common occurrence and clinical significance, there is limited awareness of AKI amongst both patients and healthcare staff which means recognition and care is often poor.


The impact of AKI on the costs of healthcare is significant. With an inpatient mortality rate for AKI of 25 to 30 per cent, NICE’s guidelines and costing statement suggests that AKI costs the NHS between £434m and £610m (2013 estimate not including community services). More recent estimates put the acute costs at more than £1bn in England.


We have been working with several trusts on initiatives to measure morbidity and mortality rates using clinical coded data with real-time baselines. However, we also recognise that to change clinical practice trusts have to consistently maintain AKI awareness and most importantly change the clinical culture towards AKI management.


At South Tees Hospital NHS Foundation Trust, a dedicated AKI advanced nurse practitioner (ANP) was recruited and trained. The ANP worked with the nephrology team to support ward and primary care teams, reinforce use of AKI guidelines and teaching materials and target improvements in AKI care in high-risk areas.


The trust was targeting a 20 per cent reduction in AKI over a full year from a June 2016 baseline. Our data by March 2017 a reduction from a starting point of 1.7 per cent of all surgical patients to just 0.6 per cent –  a fall of 65 per cent. The trust calculated that AKI was costing the trust £1.65m a year at the 1.7 per cent prevalence rate. With the difference in costs for patients with and without AKI calculated to be an average of £4,500 – total savings have been estimated at £500,000 which is a 700 per cent return on investment. The financial cost savings realised have enabled the trust to put forward a business case to recruit further AKI prevention resource in order to provide a seven day a week service 


The impact of the culture change is just as significant. We noticed that long after the awareness campaign formally ended, AKI rates continued to fall. We are continuing to monitor AKI incidence at the trust which is still seeing month on month reductions in AKI incidence. More details about the initiative can be found in the latest issue of Healthcare Finance magazine.


The awards will take place in just under two weeks’ on the 15th November at the Hilton in Gateshead time at are delivered by RTC North in partnership with the Academic Health Science Network for the North East and North Cumbria and the NIHR Clinical Research Network North East and North Cumbria.


Mark Ratnarajah, managing director, CRAB Clinical Informatics

  • 6 Nov, 2017
  • Claire Bale

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