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The Implementation of a Digitally-enabled Care Pathway for the Recognition and Management of Acute Kidney Injury

Connell, Alistair; (2019) The Implementation of a Digitally-enabled Care Pathway for the Recognition and Management of Acute Kidney Injury. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

I developed a digitally-enabled care pathway for Acute Kidney Injury (AKI) management for patients in secondary care, incorporating a mobile detection application, specialist clinical response team and care protocol. Using time-series regression, I measured changes in clinical outcome and economic data from adults with AKI before (May 2016-January 2017) and after (May-September 2017) deployment at the intervention site and at another not receiving the intervention. I extracted process of care data from casenotes and compared two nine-month periods before and after implementation (January to September 2016 and 2017, respectively) using pre-post analysis, and qualitatively evaluated the impact of using the care pathway on the working practices of users and on their interprofessional relationships using inductive and deductive thematic analysis of semi-structured interviews. There was no significant step change in the primary outcome (serum creatinine recovery to <120% baseline at hospital discharge). Among process measures, times to AKI recognition and treatment of nephrotoxicity improved significantly (p<0.001 and 0.047 respectively). Among secondary clinical outcomes, the hospital-wide cardiac arrest rate fell significantly at the intervention site (OR=0.55, 95%CI=0.38-0.76, p<0.001), but difference-in differences analysis with the comparator site was not significant (OR=1.13, 95%CI=0.63-1.99 p=0.69). Mean healthcare costs per patient admission were reduced by £1,631 (95%CI=-£3,218;-£44 p=0.044), not including costs of providing the technology. Interviews suggested that the pathway improved access to patient information and expedited early specialist care. Opportunities were identified for more constructive planning of end of life care due to the earlier detection and alerting of deterioration. However, the shift towards earlier detection also highlighted resource constraints at the intervention site, and some clinical uncertainty about the value of intervening at this stage.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: The Implementation of a Digitally-enabled Care Pathway for the Recognition and Management of Acute Kidney Injury
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2019. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10081038
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