PRACTICUM SUMMARY REPORT
Name: Amy Taylor
Team Members: Amy Taylor, Karen Marshall, Dr Samira Bell, Dr Tani Abedin
Project Title: Improving Recognition and Management of Acute Kidney Injury
University/Organization Name: University of Dundee
Health System Sponsor Name: NHS Tayside
Aim of project (1-2 sentences)
The aim of this project is to improve recognition and timely management of Acute Kidney Injury in hospitals across
NHS Tayside through use of a new electronic alert system linked to patients’ creatinine results. In 3 months, we
aim to see 95% of these e-alerts being appropriately “actioned” in 24 hours.
Planned changes tested (2-3 sentences)
We will gain baseline information on staff knowledge of Acute Kidney Injury, its importance and how to action the
electronic alerts. Furthermore, we will participate in educating staff on this topic and assess improvement in
knowledge afterwards through pre and post education questionnaires.
We will also gain information about the use of electronic alerts and how well they are being actioned on the pilot
ward (orthopaedics). Following the introduction of the electronic alerts across the hospital, we will identify a ward
requiring further intervention to improve their rates of actioning AKIs.
We will visit this ward and speak to junior doctors regarding the barriers they are facing and also display AKI
guidelines on posters throughout the ward.
Predictions (2-3 sentences)
As a result of our study, we hope to improve staff’s knowledge of AKI and improve rates of timely management of
AKI through the e-alert system. We believe this will lead to reduced patient morbidity and mortality and will
impact patients’ future CKD risk, length of hospital stay and cost to the NHS.
Results
Present your results with a graph(s).
Summary of results (3-4 sentences):
Staff scored an overall 72.4% in the pre-questionnaire compared with 80.9% in the post-questionnaire, illustrating
an increase in knowledge of AKI following education. The percentage of people who knew how to action e-alerts
correctly increased from 53.2% to 72.5%. Staff also qualitatively showed a greater understanding of the
importance of AKI following teaching. When this was translated into practice, timely actioning of e-alerts
increased from 33% to 57.1% on our target ward. This rose to 75% after speaking to junior doctor staff, reminding
and encouraging them to action e-alerts quickly and making them aware that we were analysing their results. This
figure was maintained, but not increased, by displaying posters of AKI guidelines on walls beside the computers
used to check blood results, allowing easy access when computer problems arose. Therefore, interventions
beyond education are required to reach and sustain the target. Further interventions are required to reach and
maintain the 95% target.
Learning (4-5 sentences)
Comparison of questions, predictions, and analysis of data:
In our first PDSA cycle, we wanted to determine if education would improve knowledge of AKI, its importance and
knowledge on how to action e-alerts. We predicted that this education would lead to an improvement and that
improvement would be consistent across all teaching sessions. All ward sessions did see an improvement. Higher
scores were achieved at larger formal teaching sessions for junior doctors than at informal ward based teaching for
junior doctors and nurses.
In our second PDSA cycle, we wanted to determine whether providing teaching sessions to the staff on the
orthopaedic wards would result in higher rates of appropriate actions of AKI e-alerts in 24 hours. We predicted
that education would raise the rate of appropriate AKI actions in 24 hours to over 60%. Our prediction was just
above the result of 57.1%.
In our third PDSA cycle, we wanted to establish if discussion about e-alerts with staff on the target wards would
identify barriers and whether displaying posters with guidelines on the ward next to the computers used to check
blood results, acting as a visual aid and reminder, would promote the timely management of AKI. We predicted
junior doctors would successfully identify problems and barriers but this was not the case. We also predicted
further interventions like displaying AKI guideline posters would increase rates of AKI e-alert actions to over 75%.
Our prediction was correct and 75% was reached and maintained across the orthopaedic wards by these
interventions.
Impact on systems (3-4 sentences)
Discuss the project’s significance on the local system and any findings that may be generalizable to other systems:
We hope that improvement of recognition and management of AKI will help protect patients from future chronic
kidney disease and the morbidity and mortality associated with AKI. The organisation will benefit from reduced
duration of hospital stay and consequent costs to the NHS. Junior doctors will benefit from the clear guidelines
currently available on how to investigate and manage an AKI, which is electronically linked to the e-alert and now
displayed on posters on the walls of our targeted wards. They will also benefit from higher work satisfaction by
providing better care. This will be balanced with the time taken to record actions both electronically and in patient
notes. Other organisations could adopt this electronic alert system to improve recognition and management of
AKI in their hospitals.
Conclusions (3-5 sentences)
Summarize the outcome of the project. Is this project sustainable? What are the requirements for sustainability?
The orthopaedic wards increased timely actioning of e-alerts and thus management of AKI following education and
targeted ward based interventions. This project will be sustainable if the institution is committed to using the
electronic alert system, which it is. Individual wards need to take responsibility for their own improvement too.
We have established a database that could also be used by the renal team to identify wards that need further
interventions to reach their target. However, some changes need to be made to the IT system supporting the ealerts to simplify and aid future analysis of AKI e-alerts, especially regarding the time actions were completed.
Reflections/Discussions (5-7 sentences)
Discuss the factors that promoted the success of the project and that were barriers to success. What did you learn from
doing this project? What are your reflections on the role of the team?
Factors that promoted the success of our project were the commitment of the renal team within Ninewells. They
led the promotion of e-alerts and education about AKI. The whole team took part in AKI awareness week and, by
participating in this, it allowed us to acquire the pre and post education data.
We also had help from the IT department in Ninewells. They helped us create the iPad questionnaires and
established the e-alert system across NHS Tayside.
A multidisciplinary team approach is required for the implementation of a quality improvement project itself and
all staff members must be committed to sustaining the project. The staff on the orthopaedic wards were therefore
very involved too.
We learned about the difficulty of delivering education on ward settings due to the busy nature of the clinical
environment. We also learned that although education increases knowledge, this is not always translated into
practice and further interventions are required.
We have also learned about the difficulties in analyzing a newly established electronic system. For example, when
initially analyzing the e-alert data, we could not see actions that had been cleared by staff, the date the AKI had
happened or the ward it happened on. We had to go through other IT systems we did not have access to in order
to resolve this problem. However, even when we did access some of this information, we could not identify the
time specific actions had been taken to see if they were achieved within 24 hours.
As this was only a four week project, time was also a barrier. We felt pressure to analyse all the data (especially
with all the problems accessing it) and then implement a change. We certainly learned the benefits of carrying out
PDSA cycles on a small scale on the orthopaedic wards only, since we were initially overwhelmed by all the AKIs
generated throughout Tayside.
By signing this document (electronic signature is acceptable), I attest that the information provided by the learners in
this project is accurate.
LEARNER(S):
Signature:
Signature:
Printed Name: Amy Taylor
Printed Name: Karen Marshall
Area of Study: Medical Student
Area of Study: Medical student
Signature:
Signature:
Printed Name:
Printed Name:
Area of Study:
Area of Study:
Signature:
Signature:
Printed Name:
Printed Name:
Area of Study:
Area of Study:
FACULTY SPONSOR:
HEALTH SYSTEM SPONSOR (if different from faculty sponsor):
Signature:
Signature:
Vicki Tully, NHS Tayside
Printed Name: Vicki Tully, NHS Tayside
Printed Name:
Institution:
Institution:
University of Dundee, NHS Tayside
Karen Marshall
AUTHORIZATION
Do the learners, faculty sponsor, and health system sponsor authorize this project for publication at www.ihi.org?
X Yes
☐ No