title: Impact of Compliance with a Care Bundle on Acute Kidney Injury Outcomes: A Prospective Observational Study.
abstract: BACKGROUND
  A recent report has highlighted suboptimal standards of care for acute kidney injury (AKI) patients in England. The objective of this study was to ascertain if improvement in basic standard of care by implementing a care bundle (CB) with interruptive alert improved outcomes in patients with AKI.
  
  
  METHODS
  An AKI CB linked to electronic recognition of AKI, coupled with an interruptive alert, was introduced to improve basic care delivered to patients with AKI. Outcomes were compared in patients who had the CB completed within 24 hours (early CB group) versus those who didn't have the CB completed or had it completed after 24 hours.
  
  
  RESULTS
  In the 11-month period, 2297 patients had 2500 AKI episodes, with 1209 and 1291 episodes occurring before and after implementation of the AKI CB with interruptive alert, respectively. The CB was completed within 24 hours in 306 (12.2%) of AKI episodes. In-hospital case-fatality was significantly lower in the early CB group (18% versus 23.1%, p 0.046). Progression to higher AKI stages was lower in the early CB group (3.9% vs. 8.1%, p 0.01). In multivariate analysis, patients in the early CB group had lower odds of death at discharge (0.641; 95% CI 0.46, 0.891), 30 days (0.707; 95% CI 0.527, 0.950), 60 days (0.704; 95% CI 0.526, 0.941) and after a median of 134 days (0.771; 95% CI 0.62, 0.958).
  
  
  CONCLUSIONS
  Compliance with AKI CB was associated with a decrease in case-fatality and reduced progression to higher AKI stage. Further interventions are required to improve utilization of the CB.
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, United Kingdom.
authors.forename: Nitin V
authors.initials: NV
authors.lastname: Kolhe
authors.affiliation: Department of Acute Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Staples
authors.affiliation: Department of Information Management and Technology, Uttoxeter Road, Derby, DE22 3NE, United Kingdom.
authors.forename: Timothy
authors.initials: T
authors.lastname: Reilly
authors.affiliation: Department of Information Management and Technology, Uttoxeter Road, Derby, DE22 3NE, United Kingdom.
authors.forename: Daniel
authors.initials: D
authors.lastname: Merrison
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, United Kingdom; Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Uttoxeter Road, Derby, DE22 3NE, United Kingdom.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Mcintyre
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, United Kingdom.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Fluck
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, United Kingdom; Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Uttoxeter Road, Derby, DE22 3NE, United Kingdom.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Selby
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, United Kingdom; Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Uttoxeter Road, Derby, DE22 3NE, United Kingdom.
authors.forename: Maarten W
authors.initials: MW
authors.lastname: Taal
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000368:Aged; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D064872:Patient Care Bundles; D010349:Patient Compliance; D011446:Prospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome