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Acute Kidney Outreach to Reduce Deterioration and Death (AKORDD) trial: the protocol for a large pilot study.

Abdelaziz, Tarek Samy and Lindenmeyer, Antje and Baharani, Jyoti and Mistry, Hema and Sitch, Alice and Temple, R Mark and Perkins, Gavin D and Thomas, Mark (2016) Acute Kidney Outreach to Reduce Deterioration and Death (AKORDD) trial: the protocol for a large pilot study. BMJ open, 6 (8). e012253. ISSN 2044-6055. This article is available to all HEFT staff and students via ASK HEFT Discovery tool www.heftlibrary.nhs.uk using their HEFT Athens Login.

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Official URL: http://bmjopen.bmj.com/content/6/8/e012253.long

Abstract

INTRODUCTION

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.

METHODS AND ANALYSIS

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.

ETHICS AND DISSEMINATION

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.

TRIAL REGISTRATION NUMBER

NCT02398682: Pre-results.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK HEFT Discovery tool www.heftlibrary.nhs.uk using their HEFT Athens Login.
Subjects: WJ Urogenital system. Urology
Divisions: Emergency Services > Renal
Related URLs:
Depositing User: Preeti Puligari
Date Deposited: 12 Jan 2017 14:58
Last Modified: 12 Jan 2017 14:58
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1103

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