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!
Mobile phone test can reveal vision problems in time
11.02.2016 | University of Gothenburg
Proteomics and precision medicine
08.02.2016 | University of Iowa Health Care
Today, plants and microorganisms are heavily used for the production of medicinal products. The production of biopharmaceuticals in plants, also referred to as “Molecular Pharming”, represents a continuously growing field of plant biotechnology. Preferred host organisms include yeast and crop plants, such as maize and potato – plants with high demands. With the help of a special algal strain, the research team of Prof. Ralph Bock at the Max Planck Institute of Molecular Plant Physiology in Potsdam strives to develop a more efficient and resource-saving system for the production of medicines and vaccines. They tested its practicality by synthesizing a component of a potential AIDS vaccine.
The use of plants and microorganisms to produce pharmaceuticals is nothing new. In 1982, bacteria were genetically modified to produce human insulin, a drug...
Atomic clock experts from the Physikalisch-Technische Bundesanstalt (PTB) are the first research group in the world to have built an optical single-ion clock which attains an accuracy which had only been predicted theoretically so far. Their optical ytterbium clock achieved a relative systematic measurement uncertainty of 3 E-18. The results have been published in the current issue of the scientific journal "Physical Review Letters".
Atomic clock experts from the Physikalisch-Technische Bundesanstalt (PTB) are the first research group in the world to have built an optical single-ion clock...
The University of Würzburg has two new space projects in the pipeline which are concerned with the observation of planets and autonomous fault correction aboard satellites. The German Federal Ministry of Economic Affairs and Energy funds the projects with around 1.6 million euros.
Detecting tornadoes that sweep across Mars. Discovering meteors that fall to Earth. Investigating strange lightning that flashes from Earth's atmosphere into...
Physicists from Saarland University and the ESPCI in Paris have shown how liquids on solid surfaces can be made to slide over the surface a bit like a bobsleigh on ice. The key is to apply a coating at the boundary between the liquid and the surface that induces the liquid to slip. This results in an increase in the average flow velocity of the liquid and its throughput. This was demonstrated by studying the behaviour of droplets on surfaces with different coatings as they evolved into the equilibrium state. The results could prove useful in optimizing industrial processes, such as the extrusion of plastics.
The study has been published in the respected academic journal PNAS (Proceedings of the National Academy of Sciences of the United States of America).
Exceeding critical temperature limits in the Southern Ocean may cause the collapse of ice sheets and a sharp rise in sea levels
A future warming of the Southern Ocean caused by rising greenhouse gas concentrations in the atmosphere may severely disrupt the stability of the West...
12.02.2016 | Event News
09.02.2016 | Event News
02.02.2016 | Event News
12.02.2016 | Materials Sciences
12.02.2016 | Materials Sciences
12.02.2016 | Materials Sciences