title: Acute Kidney Outreach to Reduce Deterioration and Death (AKORDD) trial: the protocol for a large pilot study.
abstract: Acute kidney injury (AKI) contributes to morbidity and mortality, and its care is often suboptimal and/or delayed. The Acute Kidney Outreach to Reduce Deterioration and Death (AKORDD) study is a large pilot testing provision of early specialist advice, to improve outcomes for patients with AKI.
  
  
  
  This before and after study will test an Outreach service for adult patients with AKI, identified using the national algorithm. During the 2-month before phase, AKI outcomes (30-day mortality, need for dialysis or AKI stage deterioration) will be observed in the intervention and control hospitals and their respective community areas; no interventions will be delivered. Patients will receive good standard care. During the 5-month after phase, the intervention will be delivered to patients with AKI in the intervention hospital and its area. Patients with AKI in the control hospital and its area will continue to have good standard care only. Patients already on dialysis and at end of life will be excluded. The interventions will be initially delivered via a phone call, with or without a visit to the primary clinician, aiming at rapidly establishing the aetiology, correcting reversible causes and conducting further appropriate investigation. Surviving stage 3 patients will be followed-up in an AKI clinic. We will conduct qualitative research using focus group-based discussions with primary and secondary care clinicians during the early and late phases of the trial. This will help break down potential barriers and improve care delivery.
  
  
  
  Patients will be contacted about the study allowing them to 'opt out'. The work of an Outreach team, guided by AKI alerts and delivering timely advice to clinicians, may improve outcomes. If the results suggest that benefits are delivered by an AKI Outreach team, this study will lead to a full cluster randomised trial.
  
  
  
  NCT02398682: Pre-results.
authors.affiliation: Department of Renal Medicine, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Tarek Samy
authors.initials: TS
authors.lastname: Abdelaziz
authors.affiliation: Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
authors.forename: Antje
authors.initials: A
authors.lastname: Lindenmeyer
authors.affiliation: Department of Renal Medicine, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Baharani
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick, Birmingham, UK.
authors.forename: Hema
authors.initials: H
authors.lastname: Mistry
authors.affiliation: Department of Epidemiology, Biostatistics and Public Health, University of Birmingham, Birmingham, UK.
authors.forename: Alice
authors.initials: A
authors.lastname: Sitch
authors.affiliation: Department of Renal Medicine, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: R Mark
authors.initials: RM
authors.lastname: Temple
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick, Birmingham, UK Department of Critical Care, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Gavin
authors.initials: G
authors.lastname: Perkins
authors.affiliation: Department of Renal Medicine, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Thomas
mesh_terms: D058186:Acute Kidney Injury / Q000191:economics / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D018450:Disease Progression; D042241:Early Diagnosis; D004739:England; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D055815:Young Adult
keywords: Acute kidney injury, community acquired; Acute kidney injury, hospital acquired; Electronic alerts; Healthcare outcomes; Outreach; Rapid response teams