Using quality improvement measures in eight of the 10 hospitals in the Northern New England Cardiovascular Disease Study Group, researchers have found a way to reduce kidney injury in patients undergoing a procedure with contrast dye.
Currently, 7-15 percent of these patients who undergo a coronary stent procedure with contrast-dye end up with kidney injury, which can result in death or rapid decline in kidney function leading to temporary or permanent dialysis, says a study published in the July issue of Circulation Cardiovascular Quality Outcomes journal.
Previous to this study, based on quality improvement methods in the hospitals, little has been done to adopt evidence-based interventions though it has been a patient safety objective of the National Quality Forum.
While researchers looked specifically at patients in the cardiology catheterization lab, they believe the methods they developed over a six-year period to prevent kidney injury are generalizable to all of medicine and contrast procedures.
"We believe that using a team-based approach and having teams at different medical centers in northern New England learn from one-another to provide the best care possible for their patients," said Jeremiah Brown of The Dartmouth Institute for Health Policy & Clinical Practice.
Brown and his colleagues found that using a quality improvement design and team coaching, they could reduce kidney injury by 20 percent among all patients and by 30 percent among patients with pre-existing chronic kidney disease.
"Some of the most innovative ideas came from these teams and identified simple solutions to protect patients from kidney injury resulting from the contrast dye exposure," Brown said. "These included getting patients to self-hydrate with water before the procedure (8 glasses of water before and after the procedure), allow patients to drink fluids up to two hours before the procedure (whereas before they were "NPO" for up to 12 hours and came to the hospital dehydrated), training the doctors to use less contrast in the procedure (which is good for the patient and saves the hospital money), and creating stops in the system to delay a procedure if that patient had not received enough oral or intravenous fluids before the case (rather, they would delay the case until the patient received adequate fluids)."
Using a simple team-based approach, Brown and colleagues from 10 medical centers in northern New England prevented kidney injury in 1 out of every 5 patients undergoing a cardiac catheterization procedure.
"Our regional success was really about hospital teams talking and innovating with one another. Instead of competing with one another in similar health care markets, they shared their data, protocols, and ideas resulting in simple, homegrown, easy to do solutions that improved patient safety across the region," Brown said.
To view the abstract of the article in the journal Circulation Cardiovascular Quality Outcomes please go to http://circoutcomes.ahajournals.org/content/early/2014/07/29/CIRCOUTCOMES.114.000903.
Jeremiah R. Brown, PhD, MS, is an Assistant Professor of The Dartmouth Institute for Health Policy & Clinical Practice and Departments of Medicine and Community and Family Medicine, Geisel School of Medicine at Dartmouth.
The Dartmouth Institute for Health Policy & Clinical Practice was founded in 1988 by Dr. John E. Wennberg as the Center for the Evaluative Clinical Sciences (CECS). Among its 25 years of accomplishments, it has established a new discipline and educational focus in the Evaluative Clinical Sciences, introduced and advanced the concept of shared decision-making for patients, demonstrated unwarranted variation in the practice and outcomes of medical treatment, developed the first comprehensive examination of US health care variations (The Dartmouth Atlas), and has shown that more health care is not necessarily better care.
Derik Hertel | Eurek Alert!
Portable finger-probe device can successfully measure liver function in potential organ donors
29.05.2015 | University of California - Los Angeles Health Sciences
Project start: New active substance targeting dreaded hospital pathogens
29.05.2015 | Deutsches Zentrum für Infektionsforschung
Many joining and cutting processes are possible only with lasers. New technologies make it possible to manufacture metal components with hollow structures that are significantly lighter and yet just as stable as solid components. In addition, lasers can be used to combine various lightweight construction materials and steels with each other. The Fraunhofer Institute for Laser Technology ILT in Aachen is presenting a range of such solutions at the LASER World of Photonics trade fair from June 22 to 25, 2015 in Munich, Germany, (Hall A3, Stand 121).
Lightweight construction materials are popular: aluminum is used in the bodywork of cars, for example, and aircraft fuselages already consist in large part of...
Using ultrashort laser pulses, scientists in Max Planck Institute of Quantum Optics have demonstrated the emission of extreme ultraviolet radiation from thin dielectric films and have investigated the underlying mechanisms.
In 1961, only shortly after the invention of the first laser, scientists exposed silicon dioxide crystals (also known as quartz) to an intense ruby laser to...
The only professorship in Germany to date, one master's programme, one laboratory with worldwide unique equipment and the corresponding research results: The University of Würzburg is leading in the field of biofabrication.
Paul Dalton is presently the only professor of biofabrication in Germany. About a year ago, the Australian researcher relocated to the Würzburg department for...
Physicists have developed an innovative method that could enable the efficient use of nanocomponents in electronic circuits. To achieve this, they have developed a layout in which a nanocomponent is connected to two electrical conductors, which uncouple the electrical signal in a highly efficient manner. The scientists at the Department of Physics and the Swiss Nanoscience Institute at the University of Basel have published their results in the scientific journal “Nature Communications” together with their colleagues from ETH Zurich.
Electronic components are becoming smaller and smaller. Components measuring just a few nanometers – the size of around ten atoms – are already being produced...
Development and implementation of an advanced automobile parking navigation platform for parking services
To fulfill the requirements of the industry, PolyU researchers developed the Advanced Automobile Parking Navigation Platform, which includes smart devices,...
20.05.2015 | Event News
18.05.2015 | Event News
12.05.2015 | Event News
29.05.2015 | Life Sciences
29.05.2015 | Earth Sciences
29.05.2015 | Physics and Astronomy