A qualitative study of nephrologists' perspectives on implementing a nephrology rapid response model for acute kidney injury.

Introduction: Acute kidney injury (AKI) poses major health and economic burdens, especially in low-resource settings like Palestine. This study explores nephrologists' perspectives on implementing the Nephrology Rapid Response Team (NRRT) model, highlighting key barriers, facilitators, and strategic priorities to improve AKI care.

Study design: A qualitative, exploratory study design was employed to gain in-depth nephrologists' perspectives on the feasibility of implementing the Nephrology Rapid Response Team (NRRT) model in Palestinian hospitals.

Methods: Thirteen board-certified nephrologists were recruited using purposive sampling. Semi-structured interviews were conducted between January and May 2024, with data transcribed verbatim and analyzed thematically using MAXQDA Analytics Pro software. Thematic analysis identified key facilitators, barriers, and recommendations. Rigorous methodological strategies ensured the credibility, dependability, and transferability of the findings.

Results: Five enablers themes emerged that could facilitate integration of the model: strategic backing from the Ministry of Health, a growing orientation toward prevention-driven healthcare policies, enhanced multidisciplinary collaboration with early nephrologist engagement, institutional endorsement through hospital-based systems, and the progressive adoption of technological innovations such as electronic alert systems and novel biomarkers. On the other hand, five dominant barrier themes emerged. These include systemic governance and policy fragmentation, financial and operational limitations, a pronounced shortage of nephrology specialists, insufficient awareness and prevention frameworks, and weak collaboration and surveillance systems-particularly the lack of a national renal registry. Despite these obstacles, nephrologists expressed optimism, offering three central recommendations to support sustainable implementation. These include systemic policy and governance reforms, investments in nephrology education and training programs, and the expansion of public awareness and prevention strategies through primary care engagement. Together, these strategies represent a foundational roadmap for overcoming structural challenges and AKI care delivery through the NRRT model.

Conclusions: This study highlights the Ministry of Health's critical role in leading reforms for NRRT implementation, emphasizing prevention, technology, and capacity-building as priorities to improve nephrology care.

Clinical trial number: Not applicable.