Mixed methods evaluation of a computerised audit and feedback dashboard to improve patient safety through targeting acute kidney injury (AKI) in primary care

Abstract

BACKGROUND\nReducing the harms associated with acute kidney injury (AKI) requires addressing a wide range of patient safety issues, including polypharmacy and transitions of care, particularly for vulnerable patient groups. Computerised audit and feedback can transform the way healthcare organisations measure, analyse and learn from quality and safety data across different care settings, potentially improving patient safety.\n\n\nOBJECTIVE\nTo implement and evaluate an audit and feedback dashboard targeting AKI to improve patient safety, focusing on factors affecting a range of user characteristics in primary care.\n\n\nMETHODS\nWe performed a mixed methods study in three stages. Semi-structured interviews were initially performed with both primary (n = 10) and secondary care (n = 5) staff to gather user requirements for six quality indicators extracted from national guidance on post-discharge AKI care. Modified indicators were implemented in the Performance Improvement plaN GeneratoR (PINGR) audit and feedback dashboard for six months, across 45 general practices in Salford. Primary care professionals were then interviewed again (n = 7) and completed usability questionnaires. This was triangulated with an interrupted time series analysis on indicator performance, alongside software usage statistics.\n\n\nRESULTS\nImprovements were observed for the indicators for medication review (+9.01 %; 95 % Confidence Interval (CI), +6.95 % to +11.06 %) and blood pressure measurement (+5.20 %; 95 % CI + 3.61 % to +6.78 %). Variable performance and engagement were observed for other indicators including AKI coding (+0.39 %; 95 % CI -1.88 % to +2.65 %), serum creatinine (-3.40 %; 95 % CI -7.66 % to +0.85 %), proteinuria (-1.08 %; 95 % CI -1.47 % to +0.32 %) and providing patient information (+0.16 %; 95 % CI -0.41 % to +0.73 %). A key facilitator to engagement was the development of champions of change , achieved through a raised awareness of high-risk patients, guidelines, inconsistencies in coding practice and evidence for quality and safety performance. Barriers related to the specificity and perceived achievability of indicators, and limitations in resources.\n\n\nCONCLUSION\nIn a six-month, quasi-experimental evaluation of an electronic audit and feedback dashboard targeting AKI, we found improvements for two out of six quality indicators. While information technology can facilitate improvements in patient safety, further allocation of protected staff time and investment into shared learning are needed to realise those improvements in practice.