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Clinical Impact and Sustainability of a Standardized Neonatal Nephrology Consult Program
Get PDFBackground/Objective: Acute kidney injury (AKI) is common in high-risk neonates and is associated with increased morbidity and mortality. Standardized programs to identify AKI exist only in a few institutions. The sustainability and clinical impact of such programs have not been described. We characterized changes in AKI incidence, neonatal nephrology consultation, and outpatient neonatal nephrology visits after implementation of a Neonatal Nephrology program. We hypothesized that neonatal AKI incidence would decrease in the post-implementation era.
Methods: We instituted a standardized Neonatal Nephrology program in early 2020 to identify AKI in infants admitted to the NICU. Elements included (1) a shared neonatology and nephrology clinical practice guideline including creatinine monitoring, (2) electronic health record alert to identify infants with AKI, and (3) standardized nephrology consultation. All neonates with AKI were seen by nephrology and infants with severe AKI (stage 2 or 3) were referred for outpatient follow-up.
Results: There was a sustained and significant decrease in AKI incidence since initiation of the program. AKI incidence decreased from 40% in 2019 before the program began to 19% in 2023. This decrease in AKI incidence correlates temporally to increased AKI identification and inpatient Neonatal Nephrology consults. While the initial burden of neonatal nephrology consults increased, with the decline in AKI incidence there has been a subsequent decrease in consultations.
Conclusions: We report a reduction in AKI incidence after implementation of a standardized Neonatal Nephrology program. While reasons are likely multifactorial, it is likely that increased AKI awareness and monitoring contributed to this decline. We believe our single center experience emphasizes the importance of multi-disciplinary work in neonatal nephrology. Future work will focus on risk stratification of outpatient management of high-risk infants, interventions focused on further reduction in AKI incidence, and development of standardized approaches for identification and risk-stratification of infants
Social, Demographic, and Behavioral Determinants of Prolonged Hospital Stay and Readmissions for Postoperative Complications in an Urban Health Care System
Get PDFBackground
The relationship between postoperative complications and social determinants of health (SDOH) is a priority issue with implications on quality of care (QOC). Extended length of stay (LOS) and readmissions (RA) are critical QOC indicators, prompting initiatives such as the Hospital Readmission Reduction Program. Surgical outcome disparities in urban settings persist yet remain underexplored. This study examined how SDOH influence readmissions and prolonged LOS among patients experiencing postoperative complications, as part of an academic-health system collaboration in Northwest Indiana.
Methods
This retrospective study analyzed an EPIC™-generated dataset with SDOH, demographics, health behaviors, and outcomes of adult inpatients hospitalized for postoperative complications at 3 urban hospitals between January 2021 and April 2024. Data analysis comprised descriptive, bivariate (Chi-Square; p<0.05), and multivariate analysis (linear and binary logistic regression; p<0.05) using SPSS 29.0. The study received exemption by Indiana University Human Research Protection Program (IRB # 14040) on 1/28/2022.
Results
The study included over 900 patients, with 565 readmissions (RA) and 337 extended LOS cases. Patients were primarily over 50 years old (81.8% RA, 81.4% LOS), White (69.4% RA, 86.3% LOS), and publicly-insured (74.8% RA, 74.7% LOS). Bivariate analysis revealed significant associations between postoperative complications and age (p < 0.001 RA, p < 0.011 LOS), veteran status (p = 0.022 RA, p = 0.058 LOS), insurance type (p < 0.001 RA), smoking status (p < 0.001 RA, p = 0.026 LOS), and BMI (p = 0.002 RA). In multivariate analysis, former smoking (OR = 2.144, p < 0.001), underweight (OR = 4.131, p = 0.006), and public insurance (OR = 3.295, p < 0.001) remained significant across all readmission durations.
Conclusion
This research highlights SDOH and health behaviors associated with prolonged hospital stay and readmissions among urban patients following postoperative complications. Policies addressing these factors before and after surgery may mitigate adverse outcomes. 
Improving Hiring, Retention, and Promotion of BIPOC Faculty
Get PDFSocial workers are responsible for dismantling systems of oppression, promoting equity and inclusion, and creating and implementing just systems. Yet the structural inequities that disadvantage historically marginalized populations, including BIPOC (Black, Indigenous, and People of Color) populations, continue to be embedded into the very thread of social work practice, education, and research. Using critical race theory, we discuss how race and racism lead to the undervaluing of BIPOC scholarship and how BIPOC scholars with intersecting identities are doubly undervalued. We provide empirical evidence and case examples illustrating undervalued BIPOC scholarship and how it continues to oppress and disempower BIPOC scholars within academia, focused on the hiring, retention, and promotion of BIPOC faculty. We end with recommendations for addressing these areas of oppression, such as convening a multi-university effort to re-think promotion criteria for scholars engaged in diversity, equity, and disparity work. Such an effort could have implications for promoting social work scholars, many of whom are BIPOC. We hope this paper initiates a timely and essential discussions, leading to new, anti-racist practices of hiring and retaining BIPOC faculty and evaluating BIPOC scholarship and related teaching and service