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Abstract: FR-PO088

Outcomes After AKI: Are We Communicating Effectively?

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Author

  • Elsayed, Ingi A S, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Stoke-on-Trent, United Kingdom
Background

Acute Kidney Injury (AKI) is widely recognised as both a prevalent and serious problem, associated with worsening of morbidity, an independent predictor of mortality & risk of development of CKD. NICE guidance (NG148) recommended improved communication between 2ry care & 1ry care, to enable appropriate follow up when needed.

Methods

We provide an institute wide (large teaching hospital, catchment area of 700,000) AKI service, comprised of consultant intensivist/nephrologist (lead) & two specialist nurses. We have implemented an e-Alert system, which integrates laboratory information system, using an NHS endorsed algorithm (based on biochemical criteria), with hospital admission systems to identify patients with AKI in real time. This generates a list that is forwarded daily to AKI team, where AKI specialist nurses review, all patients with AKI stages 2 & 3. We implemented an electronic communication system, using hospital discharge letters to document AKI, its stage and issue advice to 1ry care requesting interval repeat of kidney functions & referral to renal services where appropriate. We analysed the effeciency of this communication system, over one month (Oct 2019) and followed them up for three months afterwards.

Results

Over October 2019, we reviewed a total of 190 AKI patients, 136 of which were community-acquired AKI (71.5%). 106 of them were male (55.7%) and the median age of all patients was 74ys. 126 of patients presented with an AKI stage 2 (66.3%). Average baseline creatinine was 80.4 (SD 31) micromol/L and 92 of all patients were known to have CVD (48.4%); while 31 were to known to have CKD3 or 4 prior to presentation (16.3%). Their LOS was 14.9 days on average. By the end of the study period, 56 patients died (29.5%); 36 of whom, died during their index admission. Electronic communication was issued for 100% of all survivors at time of discharge. Yet, 25 patients did not get repeat blood tests (13%) over 3 months after index presentation. Of those who had their bloods tested, 33 pateints' creatinine levels remained above baseline (17.3%) with only One patient referred to renal services by their 1ry care physician.

Conclusion

Improved communication to ensure better quality of care & prevent further episodes of AKI, is integral to care of AKI patients. Better systems to guarantee seemless care (including long term follow up) after AKI, are needed.