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The University of Southampton
Medicine

New early warning score reduces acute kidney injury-related hospital deaths

Published: 17 September 2018
AKI early warning score
New early warning score is saving lives

Researchers at the University of Southampton have developed and implemented an early warning score to identify patients who are at risk of acute kidney injury (AKI) in hospital.

AKI is significant issue, affecting nearly 1 in 6 patients in hospital, that has many causes and can affect the function of other organs including the brain, heart and lungs. The condition is life-threatening and, if not treated quickly, a fifth of patients with AKI are not expected to survive.

When a patient is admitted to hospital, the electronic system analyses past and current creatinine blood results from the patient to flag RED if the patient has recently developed AKI. Uniquely however, using the patient’s age, medical history and acute physiological measurements such as breathing rate, the system is able to highlight those at highest risk (denoted by an AMBER alert) of developing AKI within the coming days in hospital. Those at lowest risk are given a green rating.

If a patient has an AMBER or RED score, a warning in multiple locations used by the clinical team across the hospital is triggered, highlighting the appropriate best practice management.

In a study published in PLOS ONE, the system was shown to reduce AKI-related mortality rates. In the hospital where the score was being used AKI-related deaths dropped from 27 per cent to 21 per cent whilst at a control hospital site, where the score was not being used, AKI associated mortality did not change over the study period. 

Patients with failing kidneys are not always spotted early partly because of the silent nature of its progression in comparison with for example a heart attack which is usually associated with chest pain.  A common test for kidney failure is how much of a muscle waste product called creatinine is not being dealt with by the kidneys and is being accumulated in the blood, but by the time creatinine levels start to rise, damage may already be established.

Dr Luke Hodgson, Intensive Care and Respiratory Medicine Consultant at Western Sussex Hospitals NHS Foundation Trust and Research Fellow at the University of Southampton, was part of the research team alongside Professor Paul Roderick at the University of Southampton and Professor Lui Forni at the University of Surrey. The team implemented the early warning score alongside developers Patientrack, an electronic record observation system available at the bedside that calculates the National Early Warning Score (NEWS).

He said: “AKI is a significant contributor to hospital mortality. Prevention and early recognition have proven challenging as AKI evolves silently and the signs take time to present themselves and by the time they are picked up, it may be too late. We wanted to create a test to risk stratify the likelihood of patients developing kidney injury to help clinicians prevent AKI evolving.

“Around 40 patients a year are now surviving AKI at Worthing Hospital, which is where we trialled the system, who in the past would have probably died, clearly demonstrating the value of focused medical research once applied by a supportive trust like Western Sussex Hospitals.

“We are now looking to further improve our early warning system by using urine biomarkers and monitoring fluid levels more closely, so we can further improve care for even more patients.”

The system can be integrated with hospital’s other electronic systems allowing clinicians to have real-time data available at all times. The next step is for the system to be implemented in other hospital sites across the country.

“Many hospitals have set up a “red alert” system identifying patients who have developed an acute kidney injury, but sadly, by this time, it is already too late to take the most effective action,” said Dr Richard Venn, consultant anaesthetist at Worthing Hospital and research leader.

“The unique “amber alert” identifies patients at risk of AKI, which is nearly 1 in 6 hospital admissions, and prompts care teams to make a series of early interventions which we have shown save lives.

“Unfortunately, around a fifth of patients with AKI in hospital do not normally survive but, thanks to the technical application of leading research at Western Sussex Hospitals, we have observed a 6 per cent reduction in mortality for these patients, which is a fantastic achievement.”

Donald Kennedy, UK general manager of Patientrack, added: “This is a compelling example of a University and an NHS Trust taking the initiative with innovative technology and working collaboratively together with a specialist UK SME to make important advances in patient safety, meet local clinical priorities and achieve a rapid impact for the NHS.”

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