Improving Acute Kidney Injury Management in geriatric-relevant inpatient cohort: A Two-Cycle Quality Improvement

Introduction
Acute kidney injury (AKI) is common in hospitalised older adults and associated with increased mortality, prolonged length of stay and preventable harm. NICE NG148 and Trust AKI guidelines outline essential early management standards. This project aimed to improve compliance with these standards in medical inpatients at Good Hope Hospital, with a focus on older adults.

Method
This QIP used a Plan-Do-Study-Act (PDSA) approach and was conducted on general medical wards. Cycle 1 involved retrospective review of 30 adult inpatients with KDIGO-defined AKI alerts over four weeks (April/May 2025). Compliance with documentation of cause, medication review within 24 hours, fluid status assessment, urinalysis, imaging when indicated and specialist referral was assessed using a standardised proforma. Cycle 2 involved prospective review of 30 adult inpatients (October/November 2025) following interventions including resident doctor teaching, nursing education, MDT presentation and AKI awareness posters. The majority of the cohort were older adults (80% ≥60 years; mean age 73 years, median 76 years).

Results
Key improvements noted between the cycles:
• Fluid status documented: 40% → 79.2%
• Medication review within 24h: 90% → 96.7%
• Cause documented: 53% → 56.7%
Specialist referral remained 100%. Imaging compliance (70% → 66.7%) and urinalysis (47% → 29%) were sub-optimal due to out-of-hours imaging limitations and difficulty obtaining samples in frailer patients.

Conclusion
As AKI is a major contributor to morbidity and mortality in older people, optimising early management on medical wards is essential to prevent avoidable harm. Targeted interventions improved key elements of AKI care, but ongoing challenges include urinalysis, cause documentation and timely imaging. Sustaining improvement will require ongoing re-education and embedding standards into routine practice. Future work includes focusing on early AKI management in Acute Medicine and working with Radiology to improve prioritisation and explore alternative out-of-hours imaging for high-risk patients.