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An Organisational Level Programme of Intervention for AKI: A Pragmatic Stepped-Wedge Cluster Randomised Trial

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An Organisational Level Programme of Intervention for AKI : A Pragmatic Stepped-Wedge Cluster Randomised Trial . / Selby, Nicholas; Casula, Anna; Lamming, Laura; Stoves, John; Samarasinghe, Yohan; Andrew, Lewington; Roberts, Russell; Shah, Nikunj; Johnson, Melanie; Jackson, Natalie; Jones, Carol; Lenguerrand, Erik; McDonach, Eileen; Fluck, Richard; Mohammed, Mohammed A; Caskey, Fergus.

In: Journal of the American Society of Nephrology, 21.02.2019.

Research output: Contribution to journalArticle

Harvard

Selby, N, Casula, A, Lamming, L, Stoves, J, Samarasinghe, Y, Andrew, L, Roberts, R, Shah, N, Johnson, M, Jackson, N, Jones, C, Lenguerrand, E, McDonach, E, Fluck, R, Mohammed, MA & Caskey, F 2019, 'An Organisational Level Programme of Intervention for AKI: A Pragmatic Stepped-Wedge Cluster Randomised Trial ', Journal of the American Society of Nephrology. https://doi.org/10.1681/ASN.2018090886

APA

Selby, N., Casula, A., Lamming, L., Stoves, J., Samarasinghe, Y., Andrew, L., ... Caskey, F. (2019). An Organisational Level Programme of Intervention for AKI: A Pragmatic Stepped-Wedge Cluster Randomised Trial . Journal of the American Society of Nephrology. https://doi.org/10.1681/ASN.2018090886

Vancouver

Selby N, Casula A, Lamming L, Stoves J, Samarasinghe Y, Andrew L et al. An Organisational Level Programme of Intervention for AKI: A Pragmatic Stepped-Wedge Cluster Randomised Trial . Journal of the American Society of Nephrology. 2019 Feb 21. https://doi.org/10.1681/ASN.2018090886

Author

Selby, Nicholas ; Casula, Anna ; Lamming, Laura ; Stoves, John ; Samarasinghe, Yohan ; Andrew, Lewington ; Roberts, Russell ; Shah, Nikunj ; Johnson, Melanie ; Jackson, Natalie ; Jones, Carol ; Lenguerrand, Erik ; McDonach, Eileen ; Fluck, Richard ; Mohammed, Mohammed A ; Caskey, Fergus. / An Organisational Level Programme of Intervention for AKI : A Pragmatic Stepped-Wedge Cluster Randomised Trial . In: Journal of the American Society of Nephrology. 2019.

Bibtex

@article{a219f5d70c7b4c0aa66fba552e383484,
title = "An Organisational Level Programme of Intervention for AKI: A Pragmatic Stepped-Wedge Cluster Randomised Trial",
abstract = "Background: Variable standards of care may contribute to poor outcomes associated with acute kidney injury (AKI). We evaluated whether a multifaceted intervention (AKI e-alerts, an AKI care bundle and an education programme) would improve delivery of care and patient outcomes. Methods: A multi-centre, pragmatic, stepped-wedge cluster randomised trial (SWCRT) was performed in five UK hospitals. The intervention was introduced sequentially across fixed three-month periods until all hospitals were exposed. The intervention schedule was randomly determined. All patients with AKI aged ≥18 years were included. The primary outcome was 30-day mortality, with pre-specified secondary endpoints and a nested evaluation of care process delivery. The nature of the intervention precluded blinding, but data collection and analysis were independent of project delivery teams. Findings: 24,059 AKI episodes were studied. Overall 30-day mortality was 24.5{\%}, with no difference between control and intervention periods (OR 1.04, 95{\%} CI 0.91-1.21). Hospital length of stay (LoS) was reduced with the intervention (-0.2days (95{\%} CI -0.5 to 0.1), -0.7days (-1.3 to -0.2) and -1.3days (-2.5 to -0.2) at the 0.3, 0.5 and 0.7 quantiles respectively). AKI incidence increased (adjusted incidence rate ratio 1.12, 95{\%} CI 1.03-1.22) with a parallel increase in the proportion of patients with a coded diagnosis of AKI. Process measures were assessed in 1048 patients, with improvements seen in several metrics including AKI recognition, medication optimisation and fluid assessment. Conclusions: A complex, hospital-wide intervention to reduce harm associated with AKI did not alter 30-day AKI mortality but did result in reductions in LoS, accompanied by improvements in in quality of care. AKI incidence increased, likely reflecting improved recognition.",
keywords = "acute renal failure, clinical nephrology, e-alert, care bundle, education, AKI",
author = "Nicholas Selby and Anna Casula and Laura Lamming and John Stoves and Yohan Samarasinghe and Lewington Andrew and Russell Roberts and Nikunj Shah and Melanie Johnson and Natalie Jackson and Carol Jones and Erik Lenguerrand and Eileen McDonach and Richard Fluck and Mohammed, {Mohammed A} and Fergus Caskey",
year = "2019",
month = "2",
day = "21",
doi = "10.1681/ASN.2018090886",
language = "English",
journal = "Journal of the American Society of Nephrology",
issn = "1046-6673",
publisher = "Lippincott Williams and Wilkins",

}

RIS - suitable for import to EndNote

TY - JOUR

T1 - An Organisational Level Programme of Intervention for AKI

T2 - A Pragmatic Stepped-Wedge Cluster Randomised Trial

AU - Selby, Nicholas

AU - Casula, Anna

AU - Lamming, Laura

AU - Stoves, John

AU - Samarasinghe, Yohan

AU - Andrew, Lewington

AU - Roberts, Russell

AU - Shah, Nikunj

AU - Johnson, Melanie

AU - Jackson, Natalie

AU - Jones, Carol

AU - Lenguerrand, Erik

AU - McDonach, Eileen

AU - Fluck, Richard

AU - Mohammed, Mohammed A

AU - Caskey, Fergus

PY - 2019/2/21

Y1 - 2019/2/21

N2 - Background: Variable standards of care may contribute to poor outcomes associated with acute kidney injury (AKI). We evaluated whether a multifaceted intervention (AKI e-alerts, an AKI care bundle and an education programme) would improve delivery of care and patient outcomes. Methods: A multi-centre, pragmatic, stepped-wedge cluster randomised trial (SWCRT) was performed in five UK hospitals. The intervention was introduced sequentially across fixed three-month periods until all hospitals were exposed. The intervention schedule was randomly determined. All patients with AKI aged ≥18 years were included. The primary outcome was 30-day mortality, with pre-specified secondary endpoints and a nested evaluation of care process delivery. The nature of the intervention precluded blinding, but data collection and analysis were independent of project delivery teams. Findings: 24,059 AKI episodes were studied. Overall 30-day mortality was 24.5%, with no difference between control and intervention periods (OR 1.04, 95% CI 0.91-1.21). Hospital length of stay (LoS) was reduced with the intervention (-0.2days (95% CI -0.5 to 0.1), -0.7days (-1.3 to -0.2) and -1.3days (-2.5 to -0.2) at the 0.3, 0.5 and 0.7 quantiles respectively). AKI incidence increased (adjusted incidence rate ratio 1.12, 95% CI 1.03-1.22) with a parallel increase in the proportion of patients with a coded diagnosis of AKI. Process measures were assessed in 1048 patients, with improvements seen in several metrics including AKI recognition, medication optimisation and fluid assessment. Conclusions: A complex, hospital-wide intervention to reduce harm associated with AKI did not alter 30-day AKI mortality but did result in reductions in LoS, accompanied by improvements in in quality of care. AKI incidence increased, likely reflecting improved recognition.

AB - Background: Variable standards of care may contribute to poor outcomes associated with acute kidney injury (AKI). We evaluated whether a multifaceted intervention (AKI e-alerts, an AKI care bundle and an education programme) would improve delivery of care and patient outcomes. Methods: A multi-centre, pragmatic, stepped-wedge cluster randomised trial (SWCRT) was performed in five UK hospitals. The intervention was introduced sequentially across fixed three-month periods until all hospitals were exposed. The intervention schedule was randomly determined. All patients with AKI aged ≥18 years were included. The primary outcome was 30-day mortality, with pre-specified secondary endpoints and a nested evaluation of care process delivery. The nature of the intervention precluded blinding, but data collection and analysis were independent of project delivery teams. Findings: 24,059 AKI episodes were studied. Overall 30-day mortality was 24.5%, with no difference between control and intervention periods (OR 1.04, 95% CI 0.91-1.21). Hospital length of stay (LoS) was reduced with the intervention (-0.2days (95% CI -0.5 to 0.1), -0.7days (-1.3 to -0.2) and -1.3days (-2.5 to -0.2) at the 0.3, 0.5 and 0.7 quantiles respectively). AKI incidence increased (adjusted incidence rate ratio 1.12, 95% CI 1.03-1.22) with a parallel increase in the proportion of patients with a coded diagnosis of AKI. Process measures were assessed in 1048 patients, with improvements seen in several metrics including AKI recognition, medication optimisation and fluid assessment. Conclusions: A complex, hospital-wide intervention to reduce harm associated with AKI did not alter 30-day AKI mortality but did result in reductions in LoS, accompanied by improvements in in quality of care. AKI incidence increased, likely reflecting improved recognition.

KW - acute renal failure

KW - clinical nephrology

KW - e-alert

KW - care bundle

KW - education

KW - AKI

U2 - 10.1681/ASN.2018090886

DO - 10.1681/ASN.2018090886

M3 - Article

JO - Journal of the American Society of Nephrology

JF - Journal of the American Society of Nephrology

SN - 1046-6673

ER -