Some team-based coaching interventions may reduce AKI
Medical centers that used team-based coaching interventions such as automated surveillance reporting and a virtual learning collaborative saw reductions in AKI and chronic kidney disease, according to a speaker at ASN Kidney Week.
“Over a million people in the U.S. undergo cardiac catheterization procedures each year, with AKI occurring in up to 14% of all patients. However, orders are often not standardized to ensure adequate oral and intravenous fluids, reduced [nothing by mouth] time and limited contrast dye dose across or within hospitals to prevent AKI,” Jeremiah R. Brown, PhD, professor of epidemiology and biomedical data sciences at Geisel School of Medicine at Dartmouth, said. “Team-based coaching and institution-focused efforts to standardize preventive practices can help reduce the incidence of contrast-induced-AKI.”
Researchers randomized 20 Veterans Administration medical centers in a 2x2 factorial cluster-randomized trial to receive interventions involving technical assistance, technical assistance and automated surveillance reporting, a virtual learning collaborative, or a virtual learning collaborative and automated surveillance reporting for 18 months. Clustered design was accounted for with multilevel logistic models for AKI with site-level random effects.
Each hospital was provided with the same AKI Prevention Toolkit and AKI preventive strategies. They were followed and interviewed for 18 months.
Centers in the automated surveillance reporting intervention cluster received access to surveillance tools that provided measures of the sites’ national risk-adjusted ranking, site specific performance summary and patient list.
Those in the virtual learning collaborative intervention cluster developed a multidisciplinary team with two expert coaches. Coaches attended monthly 60-minute virtual learning collaborative training calls where they reviewed the toolkits and other materials.
The centers in the technical assistance intervention cluster attended monthly one-on-one calls with an AKI improvement specialist to review questions, progress and challenges with the toolkit.
Data from these three clusters were analyzed and compared after 18 months.
Of the 4,517 patients involved, 1,153 patients had pre-existing CKD, and patient characteristics were balanced. Overall, there were 510 AKI events, including 214 among patients with CKD.
Researchers found that the virtual learning collaborative and automated surveillance reporting clusters experienced a “substantial reduction” in AKI compared with the technical assistance cluster. A similar but nonsignificant effect was seen among patients with CKD.
“IMPROVE-AKI is a randomized implementation trial and demonstrates that the combination of a [virtual learning collaborative] with [automated surveillance reporting] significantly reduces AKI by 40% and is suggestive of a comparable reduction among CKD patients,” Brown said. “Therefore, the combined [virtual learning collaborative] with [automated surveillance reporting]team-based coaching intervention is an effective, scalable intervention to establish aggressive prevention protocols to prevent AKI.”
Collapse
Brown JR, et al. Paper TH-OR08. Presented at: ASN Kidney Week; Nov. 4-7, 2021 (virtual meeting).
Read more about