title: How do centres begin the process to prevent contrast-induced acute kidney injury: a report from a new regional collaborative.
abstract: OBJECTIVE
  This study evaluates the variation in practice patterns associated with contrast-induced acute kidney injury (CI-AKI) and identifies clinical practices that have been associated with a reduction in CI-AKI. Background CI-AKI is recognised as a complication of invasive cardiovascular procedures and is associated with cardiovascular events, prolonged hospitalisation, end-stage renal disease, and all-cause mortality. Reducing the risk of CI-AKI is a patient safety objective set by the National Quality Forum.
  
  
  METHODS
  This study prospectively collected quantitative and qualitative data from 10 centres, which participate in the Northern New England Cardiovascular Disease Study Group PCI Registry. Quantitative data were collected from the PCI Registry. Qualitative data were obtained through clinical team meetings to map care processes related to CI-AKI and focus groups to understand attitudes towards CI-AKI prophylaxis. Fixed and random effects modelling were conducted to test the differences across centres.
  
  
  RESULTS
  Significant variation in rates of CI-AKI were found across 10 medical centres. Both fixed effects and mixed effects logistic regression demonstrated significant variability across centres, even after adjustment for baseline covariates (p<0.001 for both modelling approaches). Patterns were found in reported processes and clinical leadership that were attributable to centres with lower rates of CI-AKI. These included reducing nil by mouth (NPO) time to 4 h prior to case, and standardising volume administration protocols in combination with administering three to four high doses of N-acetylcysteine (1200 mg) for each patient.
  
  
  CONCLUSIONS
  These data suggest that clinical leadership and institution-focused efforts to standardise preventive practices can help reduce the incidence of CI-AKI.
authors: Dartmouth-Hitchcock Medical Center, HB 7505, One Medical Center Drive, Lebanon, NH 03756, USA. jbrown@dartmouth.edu
authors: Jeremiah R
authors: JR
authors: Brown
authors: Peter A
authors: PA
authors: McCullough
authors: Mark E
authors: ME
authors: Splaine
authors: Louise
authors: L
authors: Davies
authors: Cathy S
authors: CS
authors: Ross
authors: Harold L
authors: HL
authors: Dauerman
authors: John F
authors: JF
authors: Robb
authors: Richard
authors: R
authors: Boss
authors: David J
authors: DJ
authors: Goldberg
authors: Frank A
authors: FA
authors: Fedele
authors: Mirle A
authors: MA
authors: Kellett
authors: William J
authors: WJ
authors: Phillips
authors: Peter N
authors: PN
authors: Ver Lee
authors: Eugene C
authors: EC
authors: Nelson
authors: Todd A
authors: TA
authors: MacKenzie
authors: Gerald T
authors: GT
authors: O'Connor
authors: Mark J
authors: MJ
authors: Sarnak
authors: David J
authors: DJ
authors: Malenka
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D000368:Aged; D002985:Clinical Protocols / Q000592:standards; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007373:Interinstitutional Relations; D008297:Male; D008875:Middle Aged; D009511:New England / Q000453:epidemiology; D010348:Patient Care Team; D061214:Patient Safety; D011446:Prospective Studies
chemical_list: D003287:Contrast Media