Abdelaziz, Tarek Samy, Lindenmeyer, Antje, Baharani, Jyoti, Mistry, Hema, Sitch, Alice, Temple, R Mark, 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. doi:10.1136/bmjopen-2016-012253 ISSN 2044-6055.

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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.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Kidneys -- Diseases -- Treatment
Journal or Publication Title:	BMJ Open
Publisher:	BMJ
ISSN:	2044-6055
Official Date:	19 August 2016
Dates:	Date Event 19 August 2016 Published 7 July 2016 Accepted 20 April 2016 Submitted
Volume:	6
Number:	8
Article Number:	e012253
DOI:	10.1136/bmjopen-2016-012253
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	7 October 2016
Date of first compliant Open Access:	7 October 2016
Funder:	National Institute for Health Research (Great Britain) (NIHR)
Grant number:	grant number PB-PG-1111-26038
Adapted As:

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