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Kidney Week

Abstract: PO0236

The Quality of Discharge Summaries After AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Giles, Cameron, Queen's University, Kingston, Ontario, Canada
  • Novakovic, Milica, Queen's University, Kingston, Ontario, Canada
  • Hopman, Wilma M., Queen's University, Kingston, Ontario, Canada
  • Silver, Samuel A., Queen's University, Kingston, Ontario, Canada
Background

Patients who survive acute kidney injury (AKI) are at increased risk of hospital readmission, chronic kidney disease (CKD), and death. However, most patients are unaware they experienced AKI, emphasizing the importance of high-quality communication between inpatient and outpatient health care providers. Our objectives were to determine how often different elements of AKI were mentioned in discharge summaries and to identify predictors of discharge summary quality after AKI.

Methods

We performed a retrospective chart review of 300 randomly selected discharge summaries from 2015 to 2019. We included 150 hospitalizations before and after introduction of a post-AKI clinic in August 2017, with 50 patients from each Kidney Disease Improving Global Outcomes (KDIGO) AKI stage. We assessed each discharge summary for 10 elements, including AKI course and follow-up recommendations. We used multivariable logistic regression to determine predictors of discharge summary quality.

Results

The median number of AKI elements mentioned was 4/10 (IQR, 2-6). Follow-up with nephrology was documented for 33 (11%) patients. AKI-specific recommendations for labs and medication changes were noted in 66 (22%) and 80 (27%) discharge summaries, respectively. The odds of having a higher quality discharge summary (AKI elements ≥4/10) were greater for every increase in baseline creatinine (Cr) of 25 umol/L (OR, 1.86; 95% CI, 1.42-2.43); intrarenal etiology (OR, 2.33; 95% CI, 1.23-4.41); increased AKI severity (stage 3 or kidney replacement therapy (KRT)) (OR, 6.85 and 4.39; 95% CI, 2.83-16.59 and 1.53-12.58, respectively); inpatient nephrology consultation (OR, 10.53; 95% CI, 4.82-22.98); and discharge Cr ≥100% above baseline (OR, 4.88; 95% CI, 1.80-13.26). Discharge summary quality did not improve with the introduction of a post-AKI clinic (OR, 0.76; 95% CI, 0.44-1.31).

Conclusion

Overall discharge summary quality in AKI survivors is poor, improving modestly for patients with baseline CKD, intrarenal etiology, severe AKI, higher discharge Cr, and inpatient nephrology involvement. Most discharge summaries are missing key post-AKI elements, including Cr trajectory and AKI-specific follow-up recommendations, even in patients receiving KRT. These gaps suggest an opportunity exists to improve discharge summary quality and communication post-AKI, especially for patients not assessed by nephrology as inpatients.