Medical Research: What are the main findings of the study?
Dr. Brown: Using simple team-based quality improvement methods we prevented kidney injury in 20% of patients having a procedure in the cardiac catheterization lab. Among patients with pre-existing kidney disease, we prevent kidney injury in 30% of patients.
We believed 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. Some of the most innovative ideas came from these teams and identified simple solutions to protect patients from kidney injury from the contrast dye exposure; these included:
- Getting patients to self-hydrate with water before the procedure (8 glasses of water before and after the procedure),
- Allow patient to drink fluids up to 2-hours before the procedure (whereas before they were “NPO” for up to 12 hours and came in 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 IV fluids before the case (rather, they would delay the case until the patient received adequate fluids).Our success was really about hospital teams talking and innovating with one another instead of competing in the health care market, which resulted in simple, homegrown, easy to do solutions that improved patient safety.
Medical Research: What should clinicians and patients take away from your report?
Dr. Brown: If you are physician sending patients to a procedure that involves the use of radio contrast dye, encourage patients to drink 8 glasses of water before and after the procedure. Also write IV orders to make sure the patient receives a bolus dose of normal saline or sodium bicarbonate of 500-1000mL before and immediately following the procedure. Be sure to monitor patients, especial those patients with pre-existing kidney disease, by ordering renal function tests 2-3 days after the contrast procedure and one week following. Refer to a nephrologist if kidney injury is detected.
If you are a patient scheduled for a procedure that involves the use of radio contrast dye, drink 8 glasses of water before and after the procedure. If you have pre-existing kidney disease talk to your doctor and also a specialist (nephrologist) about how to protect your kidneys during and after the contrast procedure including close monitoring of your renal function before and up to a week after the procedure.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Brown: We conducted this study across 10 medical centers. We believe our approach is generalizable to all cath-labs, however, more work is needed to test our methods across the country. If your medical center has interest in your cath-lab participating in a research study to prevent kidney injury please contact me at firstname.lastname@example.org
Reducing Contrast-Induced Acute Kidney Injury Using a Regional Multicenter Quality Improvement Intervention
Jeremiah R. Brown, PhD, et al
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH