Development and Evaluation of Audit and Feedback for Prevention of Acute Kidney Injury during Coronary Angiography and Intervention

Abstract Background Contrast-associated acute kidney injury (CA-AKI) is a potentially preventable complication of coronary angiography and intervention. Relatively little research has been done to demonstrate how knowledge on CA-AKI prevention can be translated into clinical practice. Methods We developed, implemented, and surveyed end-users about the usability, acceptability, and utility of audit and feedback for CA-AKI prevention in Alberta, Canada. Audit and feedback reported on amount of radiocontrast dye use, hemodynamic optimization of intravenous fluids, and CA-AKI incidence for each cardiologist practicing coronary angiography or percutaneous coronary intervention, compared with peers at their site and across the province. Reports were developed through an iterative process involving interventional cardiologists throughout the design process and usability testing. Results Cardiologists participating in usability testing indicated a preference for the visual displays of data, summarizing indicators on the front page, and endorsed the value of peer-to-peer comparisons of performance measures. Seventeen of 31 eligible cardiologists from across Alberta responded to a survey evaluating the audit and feedback process. Fifteen (88.2%) respondents agreed that the data presented in the audit and feedback report was understandable, 17 (100%) respondents agreed or strongly agreed that the presentation of the report helped them better understand their performance compared with peers, and 14 (82.4%) agreed that the audit and feedback helped them identify ways to reduce the risk of AKI for their patients. Conclusions Audit and feedback was an understandable and acceptable intervention to help cardiologists identify ways to improve prevention of CA-AKI during coronary angiography or intervention.