7-Day AKI Nursing Team Leads to Secondary Care Transformation

Background: Our district general hospital, reported high mortality rates for AKI admissions of 33.2% vs UK average of 26.61%, with an adjusted standardized mortality ratio 1.09. We noted high incidence of chronic kidney disease at 5.2% (stages G3a-5), in a 36% ethnic minority population. Our median length of stay (LoS) for all Acute Kidney Injury (AKI) stages was 13 days median while UK was 12. Getting It Right First Time report showed over 75% patients are transferred to hub for dialysis later than 24 hours. This delay has led to harm in 100% of patients. We implemented a 3-member, 7-day AKI nursing service and aim to evaluate the new nursing service and its impact. Methods: We appointed 3-AKI nurses, for a 7-day service in 2022 Prospective data was collected between April 1, 2023, to March 31, 2024. Outcome data was collected on timely intervention, dialysis transfer times, number of ICU days after patient stabilised, LoS data and 90-day major adverse kidney events (MAKE90: death, renal replacement therapy). Results: The nursing team reviewed 891 patients during the study period. We noted that 78% of patients presented with community-acquired AKI (CA-AKI) and 22% had Hospital-acquired AKI. There were 54% male and 31% of the total have preexisting CKD. The mortality was 50% in G4 and G5 patients. Patients reviewed same day (within 6 hours) were 16% for AKI stage 1 and 72% for AKI stages 2/3 with MAKE 90 outcomes showing 28% mortality and 8.9% required ICU haemofiltration. The mean transfer time for dialysis was 20.19 hours, aligning with GIRFT recommendations. Patients remained in the ICU for an average of 4.92 hours post-stabilization before transfer to the dialysis unit, reducing ICU bed pressure. The mean AKI LoS was decreased to 6.99 days, with a median of 5 days (IQR 2, 9). We conclude this reduction in LoS was due to nursing input as this was the only new intervention implemented. Conclusion: The 7-day AKI nursing team has significantly improved the timeliness of renal replacement therapy decisions, reduced ICU bed utilization, and streamlined the transfer process to the regional hub. The service introduction estimates a cost-saving, assuming the entire costs associated with a bed day can be removed, the reduction in LoS can contribute £1.8 million in avoided costs. We plan to implement a community PILOT GP AKI stage reporting, with rapid review protocols potentially preventing hospital admissions.