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Introducing an AKI predictive tool for patients undergoing orthopaedic surgery.

David Paul Baird1, Fraser Rae2, Christina Beecroft3

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A new scoring tool effectively predicts and helps prevent acute kidney injury (AKI) in orthopedic surgery patients. Interventions improved medication and monitoring compliance, especially for high-risk individuals, though fluid balance monitoring needs further optimization.

Keywords:
anaesthesiahealthcare quality improvementhospital medicinepdsasurgery

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Area of Science:

  • Nephrology
  • Surgical Patient Care
  • Health Informatics

Background:

  • Postoperative acute kidney injury (AKI) is a significant complication in surgical patients, increasing mortality and chronic kidney disease risk.
  • A validated preoperative scoring tool using seven parameters has been developed to predict AKI in orthopedic surgery.
  • Implementing predictive tools and targeted interventions is crucial for improving patient outcomes.

Purpose of the Study:

  • To establish the clinical use of a preoperative AKI scoring tool in an NHS Tayside district general hospital.
  • To achieve an 80% compliance rate for the scoring tool in orthopedic surgery patients requiring overnight stays.
  • To implement an intervention bundle for high-risk AKI patients (defined as >10% risk).

Main Methods:

  • Development of an electronic scoring tool accessible via smartphone and desktop.
  • Creation of an intervention bundle integrated into the electronic tool, including posters in clinical areas.
  • Introduction of the scoring tool and interventions using four Plan-Do-Study-Act (PDSA) cycles for elective and emergency orthopedic surgery patients.

Main Results:

  • The scoring tool demonstrated accurate function and usage across PDSA cycles.
  • Compliance with the scoring tool was 79% for elective surgery but only 43% for emergency admissions.
  • Excellent compliance was observed for medication changes and postoperative blood test monitoring in high-risk patients.

Conclusions:

  • The preoperative AKI scoring tool is functional and can be accurately implemented in a district general hospital setting.
  • Targeted interventions show high compliance for medication and monitoring, suggesting effectiveness in managing high-risk patients.
  • Further efforts are needed to improve compliance with fluid balance monitoring, particularly for lower-risk patients.