Abstract: FR-PO104

Effectiveness of AKI E-Alerts in Primary Care

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Tollitt, James, Salford Royal NHS Foundation Trust, Salford, United Kingdom
  • Emmett, Lauren, Salford Royal NHS Foundation Trust, Salford, United Kingdom
  • Glynn-Atkins, Samantha Claire, NHS Salford Clinical Commissioning Group, Salford, United Kingdom
  • Darby, Denise, Salford Royal NHS Foundation Trust, Salford, United Kingdom
  • Bennett, Brandon, Improvement Science Consulting Inc., Washington, District of Columbia, United States
  • Mccorkindale, Sheila, NHS Salford Clinical Commissioning Group, Salford, United Kingdom
  • Sinha, Smeeta, Salford Royal NHS Foundation Trust, Salford, United Kingdom
  • Poulikakos, Dimitrios J., Salford Royal NHS Foundation Trust, Salford, United Kingdom
Background

AKI e-alerts in secondary care are well researched but the impact of e-alerts in primary care is unknown. The NHS AKI alert algorithm, based on KDIGO AKI classification, was implemented across primary care in UK in 2016. This project analyzed the impact of the e-alert and AKI educational outreach sessions on primary care AKI 2&3.

Methods

GP practices were randomised into 4 groups. A 2x2 factorial design exposed each group to different combinations of the 2 interventions. The study population was 258,729. Time to repeat test or hospitalisation was measured. Age <18years and dialysis patients were excluded. Repeat tests within 48hrs were considered to be the same AKI event. When analysing time to response, AKI events were excluded if no repeat test had occurred within 14 days to avoid infinite time bias. Baseline data were collected between Jan 2015-Oct 2015. The study was undertaken from Oct 2015 to Aug 2016. The follow up period was Aug 2016-Apr 2017. All groups had e-alerts after August 2016. Yates algorithm analyzed the impact of each intervention during the study period. Time to response and mortality pre and post the intervention period was analyzed using Mann U Whitney and Chi Square respectively.

Results

1807 (0.8%) primary care blood tests demonstrated AKI1-3 (78.4% AKI1, 14.8% AKI2, 6.9% AKI3). There were 391 AKI 2 & 3 from 251 patients. A total of 234 AKI events met all inclusion criteria. E-alerts demonstrated a marked reduction in mean response time (-29.2hrs) and educational outreach had a modest impact (-3.5hrs). Median response to AKI 2 & 3 pre and post interventions was 27 hours v 16 hours respectively (p=0.037). AKI event related 30-day mortality was significantly less (18.4% v 4.1% p=0.036).

Conclusion

AKI e-alerts in primary care hastens response to AKI and may reduce mortality. Educational outreach sessions further improve response time.

Figure 1: Yates algoirthm (left), response plot (right)