Using quality improvement\u00a0measures in eight of the 10 hospitals in the Northern New England\u00a0Cardiovascular Disease Study Group, researchers have found a way to reduce\u00a0kidney injury in patients undergoing a procedure with\u00a0contrast dye.<\/p>\n
Currently, 7-15 percent of these patients who undergo a coronary\u00a0stent procedure with contrast-dye end up with kidney injury, which can\u00a0result\u00a0in death or rapid decline in kidney function leading to temporary or permanent\u00a0dialysis, says a study published in the July issue of\u00a0Circulation:\u00a0Cardiovascular Quality Outcomes<\/em>\u00a0journal. Previous to this study, based on\u00a0quality improvement methods in the hospitals, little\u00a0has been done to adopt\u00a0evidence-based interventions though it has been a patient safety objective of\u00a0the National Quality Forum.<\/p>\n While researchers looked specifically at patients in the cardiology\u00a0catheterization\u00a0lab, they believe the\u00a0methods they developed over a six-year period to prevent kidney injury are\u00a0generalizable to all of medicine and contrast procedures.<\/p>\n \u201cWe believe that using a team-based approach and having\u00a0teams at different medical centers in northern New England learn from\u00a0one-another to provide the best care possible for their patients,\u201d said\u00a0Jeremiah Brown of\u00a0The Dartmouth Institute for Health Policy & Clinical\u00a0Practice<\/a>.<\/p>\n Brown and his colleagues found that using a quality\u00a0improvement design and team coaching, they could reduce kidney injury by 20\u00a0percent among all patients and by 30 percent among patients with pre-existing\u00a0chronic kidney disease.<\/p>\n \u201cSome of the most innovative ideas came from these teams and\u00a0identified simple solutions to protect patients from kidney injury resulting\u00a0from\u00a0the contrast dye exposure,\u201d Brown said. \u201cThese included getting patients to\u00a0self-hydrate with water before the procedure (8 glasses of\u00a0water before and\u00a0after the procedure), allow patients to drink fluids up to two hours before the\u00a0procedure (whereas before they were\u00a0\u201cNPO\u201d for up to 12 hours and came to the\u00a0hospital dehydrated), training the doctors to use less contrast in the\u00a0procedure (which is good\u00a0for the patient and saves the hospital money), and\u00a0creating stops in the system to delay a procedure if that patient had not\u00a0received enough\u00a0oral or intravenous fluids before the case (rather, they would\u00a0delay the case until the patient received adequate fluids).\u201d<\/p>\n Using a simple team-based approach, Brown and colleagues\u00a0from 10 medical centers in northern New England prevented kidney injury in\u00a01\u00a0out of every 5 patients undergoing a cardiac catheterization procedure.<\/p>\n \u201cOur regional success was really about hospital teams\u00a0talking and innovating with one another. Instead of competing with one another in\u00a0similar health care markets, they shared their data, protocols, and ideas resulting\u00a0in simple, homegrown, easy to do solutions that\u00a0improved patient safety across\u00a0the region,\u201d Brown said.<\/p>\n To view the abstract of the article in\u00a0the journal\u00a0Circulation: Cardiovascular Quality Outcomes<\/em>\u00a0please\u00a0go to\u00a0http:\/\/circoutcomes.ahajournals.org\/content\/early\/2014\/07\/29\/CIRCOUTCOMES.114.000903<\/a>.<\/p>\n