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Quality of care after AKI development in the hospital: Consensus from the 22nd Acute Disease Quality Initiative (ADQI) conference

      Highlights

      • Timely and accurate diagnosis can help to promote early recovery and prevent complications.
      • Quality improvement initiatives for AKI should prioritize context-appropriate evaluation while avoiding unnecessary testing.
      • Reporting the proportion of patients achieving appropriate managment should be audited and shared with clinicians periodically.
      • Engagement of dedicated multidisciplinary personnel is an essential component for the development of quality improvement programs aiming to enhance AKI management.

      Abstract

      Background

      Acute kidney injury (AKI) is independently associated with increased morbidity and mortality. Quality improvement has been identified as an important goal in the care of patients with AKI. Different settings can be targeted to improve AKI care, broadly classified these include the inpatient and outpatient environments. In this paper, we will emphasize quality indicators associated with the management and secondary prevention of AKI in hospitalized patients to limit the severity, duration, and complications.

      Methods

      During the 22nd Acute Disease Quality Initiative (ADQI) consensus conference, a multidisciplinary group of experts discussed the evidence and used a modified Delphi process to achieve consensus on recommendations for AKI-related quality indicators (QIs) and care processes to improve patient outcomes. The management and secondary prevention of AKI in hospitalized patients were discussed, and recommendations were summarized.

      Results

      The first step in optimizing the quality of AKI management is the determination of baseline performance. Data regarding each institution's/center's performance can provide a reference point from which to benchmark quality efforts. Quality program initiatives should prioritize achievable goals likely to have the highest impact according to the setting and context. Key AKI quality metrics should include improvement in timely recognition, appropriate diagnostic workup, and implementation of known interventions that limit progression and severity, facilitating recovery, and mitigating AKI-associated complications. We propose the Recognition-Action-Results framework to plan, measure, and report the progress toward improving AKI management quality.

      Conclusions

      These recommendations identified and outlined an approach to define and evaluate the quality of AKI management in hospitalized patients.

      Keywords

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