title: Improving acute kidney injury management in lower limb arthroplasty: an educational approach.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a common but preventable cause of morbidity in elective arthroplasty patients. This study aimed to review the incidence and management of AKI in patients undergoing elective lower limb arthroplasty and compare results to those after the introduction of educational measures to improve prevention, recognition and management of AKI.
  
  
  METHODS
  A retrospective case note review of all patients undergoing elective hip or knee arthroplasty between August and October 2013 was performed. Results were compared to patients treated from February to April 2014, after the introduction of a renal protection protocol, checklist poster and educational sessions. Results were statistically compared using Fisher's exact test.
  
  
  RESULTS
  Two hundred and eleven patients were included in the study: 104 in the initial cohort and 107 in the second cohort. Twenty patients (19.2 %) developed AKI in the initial cohort and 12 patients (11.2 %) in the second (p = 0.13). Recognition, documentation and management of AKI were significantly better following educational sessions and dissemination of posters throughout clinical areas, with 75 % of patients in the second cohort having their AKI documented and treated versus 30 % in the initial cohort.
  
  
  CONCLUSIONS
  This quality improvement project has demonstrated the significant impact that simple educational measures can have on improving AKI prevention, recognition and management in patients undergoing elective arthroplasty surgery. The introduction of a logical treatment checklist has been well received by both medical and nursing staff and ensures prompt and efficient management of AKI in a non-specialist area.
authors.affiliation: Department of Trauma and Orthopaedics, Altnagelvin Area Hospital, Glenshane Road, Londonderry, BT47 6SB, Northern Ireland, UK. alistairmayne@nhs.net.
authors.forename: Alistair I W
authors.initials: AI
authors.lastname: Mayne
authors.affiliation: Department of Trauma and Orthopaedics, Altnagelvin Area Hospital, Glenshane Road, Londonderry, BT47 6SB, Northern Ireland, UK.
authors.forename: Neville W
authors.initials: NW
authors.lastname: Thompson
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000517:prevention & control; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000193:education; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000193:education; D057189:Checklist; D065187:Controlled Before-After Studies; D006801:Humans; D058996:Quality Improvement; D012189:Retrospective Studies
keywords: Acute kidney injury; Arthroplasty; Audit; Education; Quality improvement