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Why Acute Kidney Injury Is Now a Top Patient Safety and Financial Priority · Becker’s Healthcare Podcast

0:00
This is Scott Becker with the Beckers HealthCare
0:03
podcast. I'm thrilled today to be joined by
0:05
one of the best and smartest leaders I
0:07
get to work with that I've known for
0:09
decades.
0:09
We're joined today by Todd Dunn.
0:12
Todd's the chief executive officer of Acuron,
0:15
Acuron Medical, and he's gonna talk to us
0:17
today about
0:19
total kidney injury
0:20
and why acute kidney injury has become an
0:23
incredibly important issue and an imperative for health
0:26
systems and people. Todd, we're gonna talk about
0:29
acute
0:30
kidney injury, and and many of us aren't
0:31
familiar with why this has become so important
0:33
and why it has financial implications the way
0:35
that it does. Be before I get started
0:38
with that, take a moment to introduce yourself
0:40
and and talk a little bit about your
0:42
career and and what you do.
0:44
Well, thanks, Scott, and always good to connect
0:47
with you as you know. It's just lovely
0:49
to reconnect.
0:50
I think, Scott, I would describe myself, and
0:53
it's often dangerous to do that as I'm
0:55
a transformer,
0:57
really. I
0:58
absolutely love figuring out how to make innovation
1:01
what we do, so transformation is what we
1:03
get.
1:05
And I've had the privilege in my career
1:08
of really working through that, and you and
1:10
I are about to have a more common
1:12
connection.
1:13
Our good friends at Taylor and Francis are
1:15
gonna publish a book that I just finished
1:18
working on called The Innovator's Journey.
1:20
But, really, that's a reflection, Scott, of my
1:23
career and how do you
1:25
really innovate within a health system to turn
1:27
something into reality.
1:30
And for years, I've just always felt that
1:33
health systems need
1:35
innovation systems that drive transformation.
1:39
So it's been a relentless focus of mine,
1:41
especially when I was with had the gift
1:42
of being at Intermountain Healthcare, as you know,
1:46
and then being with Atrium Healthcare
1:48
where I was
1:49
just under great leadership that allowed me to
1:53
push and do things that I really love,
1:56
which is where I really implemented
1:58
Acurant
1:59
for Duikin, Andrew, that we'll talk about in
2:01
a minute.
2:02
But that's where, you know, Gene Woods, who
2:05
you know, incredible leader, Jeff Rose, Scott Rissmiller,
2:09
all these amazing leaders
2:11
pushed us and pushed me personally to think
2:14
about quality of care,
2:16
access to care,
2:18
and innovating to that end. And on a
2:21
personal note, I would say
2:23
that I've always believed that empathy is the
2:26
heartbeat of health care,
2:28
and I've been fortunate in all of my
2:30
roles to to do that.
2:33
Let that be the driver of the work.
2:35
At Acuron, it's my driver, why it resonates
2:38
with me.
2:39
And
2:40
I've always thought that, you know, if we
2:42
were empathetic, we could bring kindness and healing
2:45
to the world, and that's what I love
2:47
so much about being in health care and
2:50
trying to do what I can do to
2:51
make a difference.
2:53
And, Todd, I've watched your career for a
2:55
long time, an incredible journey, incredible impact, and
2:58
and thank you for joining us today.
3:00
Take a second on acute kidney injury.
3:03
This isn't
3:05
increasingly been called out
3:07
as both a patient safety issue and a
3:09
cost driver for hospitals.
3:12
And we see it upfront and close and
3:14
personal with with a colleague of mine.
3:16
From your perspective,
3:18
what's the real impact that AKI acute kidney
3:21
injury is having today?
3:22
And what have you learned through your work
3:24
in this area?
3:26
I think you called out the most important
3:28
thing first, Scott,
3:29
is it's a patient harm
3:32
now.
3:33
CMS declared it a patient harm back in
3:35
August
3:36
2024,
3:38
and it would be alarming
3:39
for most people
3:41
to hear this number.
3:43
Last year, data tells us that there were
3:45
three point two million
3:47
acute kidney injuries in The US alone. That's
3:50
one every
3:51
ten
3:53
seconds.
3:54
It's just alarming.
3:55
And what you mentioned, you and I both
3:57
know people who've gone to hospitals with perfectly
3:59
good kidneys and may be left with chronic
4:01
kidney disease.
4:03
And it's
4:04
mainly because
4:06
we give our clinicians,
4:07
I would argue, archaic tools to take care
4:10
of the kidney that we can dive into.
4:12
And so first of all, it's a patient
4:15
harm.
4:16
I think it's
4:18
a really prevalent patient harm because we're still
4:20
giving
4:21
a blood test that tells you your kidneys
4:24
are already in trouble
4:25
and a catheter that was been invented in
4:28
the nineteen thirties.
4:29
The other thing I think I've really learned,
4:32
Scott,
4:33
is the risk of long term
4:36
harm to a patient. But then when you
4:38
look at the data to your point,
4:41
the length of stay, the readmit rate, escalation
4:44
of dialysis,
4:45
nose productivity,
4:47
and all those things that negatively impact the
4:50
hospital system
4:51
are so associated with this that it's mind
4:53
blowing. So I've just been fortunate to be
4:56
able to dive in and learn a lot
4:57
and work with some pretty great systems to
4:59
try to help solve the problem.
5:02
And talk for a second there, Todd, about
5:04
what what are some of those common blind
5:06
spots that organizations don't really think about in
5:09
terms of addressing
5:11
acute kidney injury? What are some of the
5:13
blind spots?
5:15
Well,
5:16
I hope this isn't taken as too direct.
5:19
I think one of the biggest blind spot,
5:21
Scott,
5:22
is that this isn't on every single quality
5:26
dashboard in the country.
5:28
You're blind to what you don't measure.
5:32
And
5:33
I think that not enough systems
5:37
measure this in a formal,
5:39
very visible way
5:41
across their system. I think that's a blind
5:43
spot
5:44
that I've
5:46
experienced and why it's not on every
5:49
dashboard in the country. Just I just don't
5:51
have an answer to that, but that's a
5:52
blind spot.
5:53
The other blind spot is I think a
5:55
lot of systems are
5:57
just not aware
5:59
of the old solution sets. Like, a serum
6:03
creatinine test, Scott,
6:05
tells us if your kidneys can't filter creatinine
6:08
anymore.
6:09
Some would argue that about you're down to
6:11
almost one kidney when that happens.
6:14
And I think that some just it's a
6:15
blind spot that they're not aware that that's
6:17
what we're using as the standard to tell
6:19
you, oh,
6:20
Todd Dunn's kidneys are in trouble.
6:23
The other thing they're using is a Foley
6:25
catheter that started being marketed by Bard nineteen
6:29
thirty six. It's still fundamentally the same thing.
6:31
No intelligence to it. I think it's a
6:33
blind spot, but not in a critical way.
6:36
It's just because that's what we're used to
6:38
seeing. It's that whole thing of
6:41
you can't see the forest for the trees.
6:44
Maybe another blind spot, Scott, is
6:47
we get so connected to worrying about price
6:51
versus cost.
6:53
If you look at the price of a
6:55
creatinine test, it's low.
6:57
If you look at the price of a
6:59
really simple Foley catheter, it's pretty low.
7:02
But then you ask yourself,
7:04
don't ask about the price. What's the cost?
7:08
Because we use that, how many acute kidney
7:10
injuries do we have? And so I think
7:11
it's a blind spot sometimes in our thinking
7:14
of how we
7:15
frame it up
7:17
and the way we look at it. And
7:19
maybe we make assumptions that it's just part
7:21
of the normal course of a patient.
7:23
And those four things
7:26
can blind us to really transforming what we
7:29
need to do on behalf of patients and
7:30
the health care system, really. Well, thank you.
7:32
No. And thank you for that. And and
7:34
you mentioned earlier
7:36
that the CMS has now designated AKI acute
7:39
kidney injury
7:41
as a hospital harm,
7:42
putting it further into the middle of the
7:44
quality and reimbursement conversation.
7:47
How should leaders think about
7:49
acute kidney injury
7:51
in the context of quality metrics, financial risk,
7:54
long term performance improvement? They wanna talk at
7:57
some point about what we can do about
7:58
it and what should be done about it.
8:00
But but how should health system leaders look
8:01
at this now that CMS has designated it
8:04
as a hospital harm?
8:05
The first thing that I say is something
8:07
that doctor Ruben Mesa taught me at Advocate.
8:10
You may have heard him talk about this,
8:12
the loved one standard.
8:14
Like, if our loved one was in that
8:16
bed,
8:18
would they be thrilled? Would we be thrilled
8:21
with the tools and solutions and care that
8:23
they're getting? I think we always have to
8:25
keep that right in the center of it.
8:28
Regarding the quality metric, so starting in 2028,
8:33
hospitals have to start reporting
8:35
stage two acute kidney injury or above.
8:39
So the way I think they need to
8:40
start thinking about it now
8:42
is
8:43
what could we possibly do
8:47
to prevent
8:48
or to get an earlier recognition
8:51
of what we could do to prevent going
8:53
to stage two or stage three acute kidney
8:56
injury? So we have to think about it,
8:58
but I'd love where you're going with that,
8:59
Scott.
9:00
They need the first thing they need to
9:02
do is pull their acute kidney injury data
9:06
and start creating enormous visibility and dialogue around
9:09
this so that they get ahead of the
9:10
CMS penalties. You remember CAUTIs? I mean, can
9:13
you imagine
9:15
not measuring CAUTIs or falls?
9:17
This is in the same category of a
9:19
harm.
9:20
The cost part,
9:22
the things that we measure today are connected
9:24
to this.
9:26
Length of stay is often a margin erosion
9:29
problem.
9:30
A readmit rate is absolutely one. You don't
9:32
get paid if they come back, especially around
9:34
cardiac procedures.
9:36
You escalate to dialysis. So look at this,
9:39
those measures, and how they radiate to things
9:42
that you already care about is what I
9:44
would do
9:46
and really put that right in the center
9:47
of your quality and your cost conversations because
9:50
to your point, Scott, you can't
9:52
isolate either one of those. They interact very
9:54
well together.
9:57
A 100%. And and talk about clinicians. As
10:00
clinicians are dealing with some of the challenges
10:02
they have, heavy workload, lots of burnout,
10:06
How can better use of automation and monitoring
10:10
improve what's going on with kidney care? How
10:12
can we use automation,
10:14
monitoring to to help? Because a lot of
10:17
you're talking about makes so much sense. Three
10:20
point two million acute kidney injuries a year,
10:22
that's a lot. It has lots of long
10:23
term impact.
10:25
We've gotta deal with it, but people are
10:27
overwhelmed and just more personal touches are
10:30
maybe needed but hard to do. How can
10:32
we use automation and monitoring
10:34
to really reduce
10:36
documentation burden and get better here
10:39
at at taking care of kidney care and
10:41
avoiding acute kidney injury?
10:44
I think if you look at the head
10:45
of a bed in the OR, the ICU,
10:47
you see how we have absolutely automated
10:50
and digitized the vital signs of the heart
10:53
and lungs.
10:54
We have it. That has taken off the
10:56
monitoring burden,
10:58
the documentation
10:59
burden from teams.
11:01
And, also,
11:02
what that does, Scott,
11:04
the automation,
11:07
we automate urine flow. We automate the measurement
11:10
of it. We automate the indication of a
11:13
problem based on a global standard, and we
11:15
send that data to your electronic medical record.
11:18
It moves you from high variability
11:21
of understanding
11:22
and work
11:24
to high reliability. And because you automate it,
11:26
you basically take the work off
11:29
the nurse's plate
11:31
to manage that flow of urine or to
11:34
document it. But another thing that I think
11:37
a lot about, Scott, and
11:38
you so wisely call this out,
11:41
is the think flow.
11:43
When you automate
11:45
manual things, you take the burden off of
11:49
the think flow or what some people talk
11:51
about cognitive
11:52
burden.
11:53
And now you're giving the doctors
11:56
in addition to the perfect data they have
11:58
on the heart and the lungs, you're giving
12:00
them perfect fluid data and status of the
12:03
kidney. So you took the manual work away.
12:06
You gave them highly reliable data to make
12:08
better decisions,
12:10
and that's where the value comes in. Now
12:12
they know a really good picture of fluid
12:15
status
12:16
and how your other vital
12:18
organ,
12:19
the kidney, which has never been digitized, is
12:21
now performing.
12:23
And that just I read the other day,
12:24
this is mind blowing to me because my
12:26
mom was a nurse until she was 75.
12:28
My brother's still a nurse.
12:30
That an ICU nurse has at least a
12:33
100 tasks an hour.
12:35
And so
12:37
the study said it takes about five minutes
12:38
per hour per bed to manage
12:41
kidney output.
12:42
Now if you automate that and take it
12:44
down to five minutes a day, you give
12:46
them back time to spend one on one
12:48
with the patient just like they want to.
12:51
And and not only give them back time
12:52
to spend with the patient, just to give
12:54
them freedom to actually focus on the important
12:56
things and not be so exhausted. And and
12:58
the intentionality
12:59
of making this a core measure, watching it
13:01
all the time,
13:02
could could drive down the cost of this,
13:04
can drive down the amount of acute kidney
13:06
injury. There's so many positive impacts if we
13:08
get on this, like, we've gotten on so
13:10
many other things like falls and other things
13:12
that you've that you've mentioned and sepsis and
13:14
other things.
13:16
Talk a bit about you've had this evolution.
13:18
You're now a chief executive officer.
13:21
As you look at health systems scaling innovation,
13:24
what are the biggest barriers to adoption of
13:27
technology
13:28
or other innovation?
13:30
And what advice would you give to people
13:32
trying to operationalize
13:34
new technology and and do it at scale
13:36
and its size?
13:38
I think the first thing, Scott,
13:41
to really good adoption
13:44
is to understand what's going on in the
13:47
context of where
13:48
you would be adopted.
13:51
If I go back to this,
13:53
the way that doctor Jeff Rose said go
13:55
see the problem
13:57
and allowed my team and I through our
13:59
innovation system to do it, we spent time
14:02
in the operating rooms. We spent time in
14:04
the ICUs
14:05
moving from the OR to the ICU.
14:08
If you will really empathetically
14:10
go and understand
14:12
the complexity
14:15
that teams deal with.
14:16
Diagnosed before you prescribe may be the most
14:19
succinct way to see it,
14:21
is that you will know the problem in
14:24
context,
14:25
and you will be able to bring the
14:27
right product in to solve the problem.
14:30
And if you align your
14:33
solution with the problem and the struggles, the
14:36
teams will typically pull it into their lives
14:38
versus you having to push it. That's the
14:40
way I think about adoption
14:41
in context.
14:43
The other one is that you really need
14:45
the data to drive the dialogue.
14:48
If you don't have the data to
14:51
say that it's a problem, but even more
14:53
importantly to prioritize the problem. So you think
14:56
about this is a harm now. Acute kidney
14:57
entry is a harm.
14:59
Get the data. Get the ruling. That's another
15:02
thing that will help in organizational
15:04
adoption.
15:05
The other thing I would say is you
15:07
really need to understand the business model of
15:09
it. I loved your earlier question
15:12
also of
15:13
how does this magnify in a bad way
15:15
for a hospital system in the quality and
15:18
financial metrics?
15:20
And if you pull the data and you
15:21
realize, like, not only is this a human
15:24
problem, like your friend who suffers from chronic
15:26
kidney
15:27
disease, but this is a financial problem.
15:31
And payers aren't giving hospitals more money.
15:35
And so then you look at the margin
15:37
erosion that this is causing.
15:39
You have then adoption in context.
15:41
You have adoption at the administrative and dialogue
15:45
level between multiple service lines, and then you've
15:48
got a business reason to transform.
15:51
And if you get all three legs of
15:53
those stools, Scott, and you think about everyone
15:56
in the movie that has to be there,
15:58
the unifying thing will be the empathy of
16:01
a system to give you perfect care.
16:04
And then the driving thing will be we
16:06
have to do this,
16:07
financially
16:09
and to avoid harm.
16:12
Thank you very, very much. And and and,
16:14
Todd, talk about you've been beating the drum
16:16
for the last several years about the importance
16:18
of acute kidney injury, and I can't tell
16:21
you how much you appreciate it and what
16:22
an education I am getting around acute kidney
16:25
injury and how important is this. Three point
16:27
two million cases a year,
16:30
continuous impact. The cost impact is dramatic. The
16:33
impact on patients' lives if they end up
16:36
with this and it doesn't get fixed is
16:38
a disaster. It's very challenging.
16:40
What are you most focused on? We're in
16:42
2026
16:45
now. What are you most focused on for
16:45
rest of this year, and what are you
16:46
most excited about?
16:48
The thing I'm most focused on, Scott, is
16:51
encouraging systems to pull their data and to
16:54
understand the harm measure.
16:56
The second thing is is for them to
16:58
see
17:00
the blind spots that you mentioned.
17:03
They need to see that their clinical teams
17:06
are relying on outdated solutions
17:08
to produce modern care outcomes.
17:12
And I believe that by focusing
17:15
on creating awareness to your point around
17:18
the harm that it's causing patients, because not
17:20
one hospital wants to harm anyone
17:23
ever.
17:24
And then to see that, wait a minute.
17:27
Our clinical teams have the heart and lungs
17:30
digitized, but
17:32
we're giving old outdated tools to the kidneys
17:35
as part of fluid management.
17:37
If they can see those two things
17:40
and harness their own empathy,
17:43
then we have great dialogues with these systems
17:45
because we're just there to help.
17:48
The thing that I'm most excited about, Scott,
17:50
is
17:51
one patient at a time. You know, we've
17:53
treated
17:54
over a 125,000
17:56
patients now.
17:57
Like I mentioned, Advocate is a wonderful customer.
18:00
There are many others. We serve the VA.
18:02
So I'm most excited about
18:05
bringing
18:06
an amazing transformative solution set, a kidney monitoring
18:10
platform
18:11
that helps you
18:13
really monitor, manage, and measure the kidneys
18:16
that gives you early signal to patient distress.
18:19
That's what I'm most excited about it. Because
18:21
if we can make a difference at the
18:22
bedside for the patient and the clinical teams,
18:24
the rest benefit. Right? Our company does health
18:27
systems do in the industry overall.
18:30
And
18:31
just like you love to make an impact
18:33
and help us
18:34
improve health care, that's our passion at Acurant
18:37
is to help protect kidneys one patient at
18:39
a time.
18:40
Todd, it's incredibly a pleasure to get to
18:43
visit with you today on the Becker's Healthcare
18:45
podcast.
18:46
Incredible innovator, incredible leader. I I wanna thank
18:49
you for joining us today, and I wanna
18:51
thank you for Akron to to Akron Medical,
18:53
the company that you lead up. Thank you
18:55
so much for taking the time and and
18:57
sharing your thoughts with us today. It's always
18:59
fantastic to visit with you. You're you're one
19:01
of a kind, brilliant, great leader, and totally
19:04
on board with what we have to do
19:05
around acute kidney injury. Todd, thank you so
19:08
much. Todd Dunn, thank you. Thanks, Scott.