Reducing Postoperative Acute Kidney Injury: A Regional Quality Improvement Initiative of 26 Community-Based Hospitals

IF 3 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety Pub Date : 2026-04-01 Epub Date: 2026-01-24 DOI:10.1016/j.jcjq.2026.01.003

Aarthi Vijaykumar MD, MSHQS, CPE, FASN (is Nephrologist, Advocate Sherman Hospital, and Nephrology Associates of Northern Illinois, Elgin, Illinois.), David Goodman MD, PhD (is Medical Director of Quality and Safety, Advocate Good Shepherd Hospital, Barrington, Illinois.), Robert Whitcomb MD (is Vice President and Chief Medical Information Officer – Perioperative Medical Informatics, Advocate Health.), Michelle Ruther MBA, MSN, RN (is RN Manager of Aligned Projects, Clinical Effectiveness, Advocate Health, Crest Hill, Illinois.), Alex Miloshov MBA (is Manager of Data Analytics, Managed Health, Specialty Engagement and Value Initiatives.), Matt Pallini MS (is Director, Data Science, Advocate Health, Downers Grove, Illinois.), Jamie Layton RN (is Senior Clinical Information Analyst, Advocate Health, Oak Brook, Illinois.), Debra O’Connor DO (is Vice President of Specialty Engagement and Value Initiatives, Enterprise Population Health, Advocate Health. Please address correspondence to Aarthi Vijaykumar)

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引用次数: 0

Abstract

Background

Postoperative acute kidney injury (PO-AKI) is a leading surgical complication across multiple surgical service lines within Advocate Health’s Midwest Region. Analysis revealed significant intersite and temporal variability in PO-AKI incidence, reflecting the lack of a standardized prevention framework. In response, a multifaceted quality improvement initiative was launched to standardize prevention strategies for elective surgical admissions through the implementation of evidence-based clinical decision support (CDS) tools, including risk assessment models, practice alerts, and order sets with mitigation care bundles.

Methods

A multidisciplinary team collaboratively developed and implemented the PO-AKI reduction initiative. Using regional data analytics, the team created a risk stratification tool to identify at-risk patients. Evidence-based alerts and care bundles were embedded into the electronic health record (EHR) and deployed across 26 sites in Illinois and Wisconsin. Implementation was guided by improvement science methodologies to accelerate adoption of CDS tools.

Results

At baseline in April 2021, PO-AKI rates averaged 1,031 cases per month. Phase 1 of the intervention introduced intraoperative hypotension alerts for anesthesia teams, resulting in a 33% reduction in intraoperative hypotension episodes. With the full implementation of risk tools, alerts, and order sets in Phase 3, AKI incidence declined to 400 cases per month. Process control analysis showed sustained improvement from baseline. For those who developed PO-AKI, a reduction in length of stay from baseline was observed.

Conclusion

This initiative demonstrates that standardized, multidisciplinary approaches, particularly those leveraging EHR–integrated CDS and improvement science strategies, can meaningfully reduce PO-AKI and clinical variation across a regional healthcare system.

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减少术后急性肾损伤：26家社区医院的区域质量改进倡议。

背景：术后急性肾损伤（PO-AKI）是倡导健康中西部地区多个外科服务线的主要手术并发症。分析显示，PO-AKI发病率在地点和时间上存在显著差异，这反映了缺乏标准化的预防框架。为此，启动了一项多方面的质量改进倡议，通过实施循证临床决策支持（CDS）工具，包括风险评估模型、实践警报和带有缓解护理包的订单集，使选择性手术入院的预防策略标准化。方法：一个多学科团队合作开发并实施了减少PO-AKI的倡议。利用区域数据分析，该团队创建了一个风险分层工具来识别高危患者。基于证据的警报和护理包被嵌入到电子健康记录（EHR）中，并部署在伊利诺伊州和威斯康星州的26个站点。实施工作以改进科学方法为指导，以加速采用CDS工具。结果：在2021年4月基线时，PO-AKI发生率平均为每月1,031例。干预的第一阶段为麻醉小组引入术中低血压警报，导致术中低血压发作减少33%。随着第三阶段风险工具、警报和命令集的全面实施，AKI发病率下降到每月400例。过程控制分析显示从基线开始持续改善。对于发生PO-AKI的患者，观察到住院时间较基线缩短。结论：这一举措表明，标准化的多学科方法，特别是那些利用ehr集成CDS和改进科学策略的方法，可以有意地减少poi - aki和整个区域医疗保健系统的临床差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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