Cardiac catheterization and intervention procedures are important for diagnosing and treating heart conditions. However, some people are at high risk of kidney injury from the procedures, which can present challenges for those living with CKD.
To lower the chances of this happening, Dr. Matthew James, an Associate Professor and Clinician Scientist at the University of Calgary, and other members of the APPROACH team, implemented a decision aid tool to support cardiology teams in identifying patients at high risk of kidney injury and taking steps to reduce kidney disease following the procedure.
Once a high-risk patient is identified using the tool, special steps can be taken to lower the amount of contrast dye used during the procedure and to maintain adequate fluid levels throughout.
This past September, the APPROACH team reported that their strategic intervention resulted in a significant decrease in the number of patients who incur kidney damage from the procedure – by about 30 percent – following the project’s implementation across Alberta.
James notes several factors contributing to the project’s success, including the introduction of a decision support tool into practice at the point of care.
“It’s hard to accurately estimate the risk for each individual patient encountered and tailor their care appropriately to make a procedure as safe as possible for each person,” explains James. “The introduction of these decision support tools provides health care teams with this information right at the time they need it to make a decision about how to perform a patient’s procedure.”
Importantly, the APPROACH team also provided care teams with feedback on their progress every three months, so medical staff could see the impact of their care processes over time. James says other factors supporting the project include data collected through a unique electronic health information system and collaboration among the different care team members. For example, nurses were responsible for completing risk models and identifying patients at risk of kidney disease, while radiology technicians notified the care team about safe contrast dye levels and reported when these levels were approached. Physician champions at each centre also helped drive change, James says.
Data were collected over the course of the study to evaluate its effectiveness, capturing the outcomes of more than 7,000 patients receiving heart procedures across Alberta who were identified as high-risk for kidney disease following procedures.
“These results were really exciting for us because they showed that the project achieved its goals,” says James.