Reducing Postoperative Acute Kidney Injury: A Regional Quality Improvement Initiative of 26 Community-Based Hospitals

Postoperative acute kidney injury (PO-AKI) is a leading surgical complication across multiple surgical service lines within Advocate Health's Midwest Region. Analysis revealed significant intersite and temporal variability in PO-AKI incidence, reflecting the lack of a standardized prevention framework. In response, a multifaceted quality improvement initiative was launched to standardize prevention strategies for elective surgical admissions through the implementation of evidence-based clinical decision support (CDS) tools, including risk assessment models, practice alerts, and order sets with mitigation care bundles.

A multidisciplinary team collaboratively developed and implemented the PO-AKI reduction initiative. Using regional data analytics, the team created a risk stratification tool to identify at-risk patients. Evidence-based alerts and care bundles were embedded into the electronic health record (EHR) and deployed across 26 sites in Illinois and Wisconsin. Implementation was guided by improvement science methodologies to accelerate adoption of CDS tools.

At baseline in April 2021, PO-AKI rates averaged 1,031 cases per month. Phase 1 of the intervention introduced intraoperative hypotension alerts for anesthesia teams, resulting in a 33% reduction in intraoperative hypotension episodes. With the full implementation of risk tools, alerts, and order sets in Phase 3, AKI incidence declined to 400 cases per month. Process control analysis showed sustained improvement from baseline. For those who developed PO-AKI, a reduction in length of stay from baseline was observed.

This initiative demonstrates that standardized, multidisciplinary approaches, particularly those leveraging EHR-integrated CDS and improvement science strategies, can meaningfully reduce PO-AKI and clinical variation across a regional healthcare system.