AKI-Standardized Clinical Assessment and Management Plan reduces ICU length of stay
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An AKI-Standardized Clinical Assessment and Management Plan correlated with reduced ICU length of stay when tested in a 12-month period, according to data published in the Clinical Journal of the American Society of Nephrology.
Further, the AKI-Standardized Clinical Assessment and Management Plan (SCAMP) did not significantly correlate with inpatient mortality.
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“Acute kidney injury is associated with high rates of mortality and resource utilization,” Yvelynne P. Kelly, MD, PhD, a consultant intensivist at Tallaght University Hospital in Dublin and a senior clinical lecturer at Trinity College Dublin in Ireland, told Healio. “We wished to assess whether use of a clinical decision support system to standardize decision-making regarding timing of initiation of renal replacement therapy would have a significant impact on patient outcomes including mortality and hospital/ICU length of stay.”
In a 12-month controlled study of time periods, researchers measured the use of an AKI- SCAMP in nine ICUs. The AKI-SCAMP group consisted of 122 patients, and 102 patients remained in the control group. Researchers alternated use of the AKI-SCAMP with use of a “sham” control form in 4- to 6-week periods. Eight board-certified nephrologists attending on the ICU services were assigned to SCAMP or a “sham” form on a rotating schedule, but patients remained in their group for the duration of the study.
The primary outcome of the study was the risk of inpatient mortality.
Assessments revealed no significant difference in inpatient mortality correlated with AKI-SCAMP use. However, AKI-SCAMP was associated with reduced ICU length of stay and hospital length of stay. Similarly, patients in the AKI-SAMP group were less likely to receive kidney replacement therapy than those in the control group.
“The risk of mortality and prolonged length of stay associated with AKI remains high, with few interventions to date that have been shown to impact these outcomes for patients with AKI requiring renal replacement therapy. Similarly, our study shows that timing of renal replacement therapy initiation may not impact mortality but suggests that standardization of renal replacement therapy initiation may impact other outcomes, like length of stay,” Kelly told Healio. “The shorter length of stay observed in the AKI-SCAMP cohort is likely impacted by a significantly higher rate of renal replacement therapy use in the control group for those in whom renal replacement therapy was thought to be futile. Use of the AKI-SCAMP may therefore encourage standardization of decision-making related to renal replacement therapy initiation despite treatment futility, which can affect health care utilization including length of stay.”
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