Reducing contrast-induced acute kidney injury using a regional multicenter quality improvement intervention.
Reducing contrast-induced acute kidney injury using a regional multicenter quality improvement intervention.
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DOI：
10.1161/circoutcomes.114.000903
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发表时间：
2014-09
期刊：
影响因子：
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通讯作者：
Northern New England Cardiovascular Disease Study Group
中科院分区：
文献类型：
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作者：
Brown JR;Solomon RJ;Sarnak MJ;McCullough PA;Splaine ME;Davies L;Ross CS;Dauerman HL;Stender JL;Conley SM;Robb JF;Chaisson K;Boss R;Lambert P;Goldberg DJ;Lucier D;Fedele FA;Kellett MA;Horton S;Phillips WJ;Downs C;Wiseman A;MacKenzie TA;Malenka DJ;Northern New England Cardiovascular Disease Study Group
Contrast-induced acute kidney injury (CI-AKI) is associated with increased morbidity and mortality following percutaneous coronary interventions (PCI) and is a patient safety objective of the National Quality Forum. However, no formal quality improvement program to prevent CI-AKI has been conducted. Therefore, we sought to determine if a six-year regional multi-center quality improvement intervention could reduce CI-AKI following PCI. We conducted a prospective multi-center quality improvement study to prevent CI-AKI (serum creatinine increase ≥0.3 mg/dL within 48 hours or ≥50% during hospitalization) among 21,067 non-emergent patients undergoing PCI at ten hospitals between 2007 and 2012. Six ‘intervention’ hospitals participated in the quality improvement intervention. Two hospitals with significantly lower baseline rates of CI-AKI, which served as “benchmark” sites and were used to develop the intervention and two hospitals not receiving the intervention were used as controls. Using time series analysis and multilevel poisson regression clustering to the hospital-level we calculated adjusted risk ratios (RR) for CI-AKI comparing the intervention period to baseline. Adjusted rates of CI-AKI were significantly reduced in hospitals receiving the intervention by 21% (RR 0.79; 95%CI: 0.67 to 0.93; p=0.005) for all patients and by 28% in patients with baseline eGFR<60 ml/min/1.73 m2 (RR 0.72; 95%CI: 0.56 to 0.91; p=0.007). Benchmark hospitals had no significant changes in CI-AKI. Key qualitative system factors associated with improvement included: multidisciplinary teams, limiting contrast volume, standardized fluid orders, intravenous fluid bolus, and patient education about oral hydration. Simple cost-effective quality improvement interventions can prevent up to one in five CI-AKI events in patients with undergoing non-emergent PCI.
