Blog 1: AQ Detection and Response – a combined focus on AKI, pneumonia and sepsis

The Advancing Quality (AQ) programme has a long history supporting improvement work in acute kidney injury (AKI), sepsis and pneumonia. We’ve collected data and reported on AKI and sepsis since 2014 and community acquired pneumonia (CAP) since the start of our programme in 2008 and have supported communities of practice by holding regular, condition-specific collaborative events, usually twice a year and usually in the spring and autumn. This time around, we decided to try something different.

Over the next few days, we’ll be detailing and reflecting on our AQ Detection and Response event, which took place at Haydock Park racecourse on 11^th October 2019. The day combined what would previously have been three separate events into one, to give a wider focus on AKI, sepsis and pneumonia collectively. These three conditions are highly prevalent, carry significant mortality risks and often occur together. The aim was to connect teams across the region and across disciplines and think about care for the deteriorating patient more holistically.

Game changing technology

Our Programme Manager Liz Kanwar kicked off the day, welcoming delegates and describing the structure of the event, comprising two plenary keynotes and a three strand programme running simultaneously, where delegates could choose where they wanted to go. Liz set out the aims of the day: showcase excellent work from across the region, increase understanding of data to measure improvement, provide networking opportunities, hear the voice of the patient in care delivery and for us at AQ to listen and capture ideas. Liz then introduced our first keynote, Dr Chris Laing, who is a Consultant nephrologist at University College Hospital and the Royal Free London, as well as Divisional Clinical Director for Emergency Services. Chris shared a stark and startling statistic that 15% of patients who develop an AKI will develop chronic kidney disease within one year. He described the important collaborative work taking place in south-west London and also the development of an AKI app at Royal Free, an innovative method of managing AKI patients. Through artificial intelligence, the app can predict which patients are likely to develop an AKI, improving the speed and accuracy of recognition and enabling better targeting of care for those who need it most. Although the app is just being used at Royal Free at the moment, Chris described it as proving itself able to adapt to and learn from other clinical environments, making this a breakthrough use of technology that is a potential game changer in the diagnosis, prevention and timely treatment of AKI.

Dr. Chris Laing describes how smart technology improves AKI detection 

Take a structured approach and keep the patient informed

We then split into three for our first section of parallel sessions concentrating on particular aspects of AKI, sepsis and pneumonia patient care.

In our sepsis session, Jane Mastin, an infection prevention and control nurse at Lancashire County Council, shared the work they have been doing around developing and delivering education and training, supporting care home staff in recognising and escalating deteriorating patients in a timely manner. As most cases of sepsis develop in the community rather than in hospital, this is something that can save lives and improve outcomes. Following on from this, Liz Kanwar presented some local analysis on sepsis admissions from care homes against the AQ measures. The results, from a small sample, showed that patients from care homes are older, are more likely to suffer from frailty, stay in hospital longer and have a higher rate of mortality. Care home patients are a group who can really benefit from a coordinated, structure approach, such as an advanced care plan. In our first pneumonia session, Jo Higgins, AQ Senior Improvement Advisor, introduced films of pneumonia patient stories, kindly provided by Dr Dan Wootton. More about Dan and his work later. These stories show that anyone can develop pneumonia.

One patient, a fitness instructor, described how surprised she was to develop pneumonia and how debilitating a condition it is, saying “I always thought pneumonia was something older people got, or people who were unfit”. Another participant, eighty-six years old, highlighted the importance of keeping the patient informed, something she felt that isn’t always done with older patients: “if you get the right information and you can get it immediately…I can go home then and deal with it”. This was followed by Patrick McDermott, a pneumonia nurse at Royal Liverpool, who talked about the improvement work AQ has done with the trust to improve diagnosis and coding and bring down reported in-hospital mortality from 17.7% in the first half of 2018 to 13.2% in the first half of 2019. The Royal Liverpool Pneumonia Steering Group is a great example of how improvements can be made when there is sustained engagement across teams and a structured approach.

Our blog tomorrow will focus on AKI, the use of data and new innovative approaches to help reduce readmission rates.