Dr. Robert Gayner, VPMA, St. Luke's University Hospital – Bethlehem, and chief of Nephrology, St. Luke's University Health Network
St. Luke's University Hospital — Bethlehem
Dr. Robert Gayner, chief of nephrology at St. Luke's University Hospital Network, working with a multidisciplinary team, discovered that many patients were being misdiagnosed with acute kidney injury (AKI) or had undiagnosed AKI. As patients' electronic health records often retain diagnoses, these inaccuracies had the potential to cause unnecessary treatments and put patients at higher risk for AKI comorbidities.
Dr. Gayner worked diligently to educate caregivers about the Kidney Disease Improving Global Outcomes (KDIGO) criteria for diagnosing AKI throughout the hospital. Among the many components of this educational outreach, he and the team developed a standardized AKI bundle to help all network inpatient and outpatient providers recognize AKI and identify patients at high risk for AKI when they arrive for a surgical procedure.
Dr. Gayner also issued a set of practice standards to mitigate the risk of AKI, which includes a preoperative nephrology consult for patients depending on their baseline kidney function. He worked closely with the clinical informatics team to automatically identify patients who were at risk for AKI or who had an AKI event in the hospital and trigger clinical decision-making support mechanisms to assure timely and effective care across all disciplines.
These initiatives have been implemented networkwide and have resulted in a 37% reduction in the overall rate of AKI; decreased patient mortality; and improved appropriate diagnosis, treatment, and ongoing management of this patient population.