Abstract: SA-PO102
Assessing Discharge Communication and Follow-Up of AKI: An Opportunity for Quality Improvement
Session Information
- AKI: Epidemiology, Risk Factors, Prevention - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Al-Zeer, Bader, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Birks, Peter C., The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Holmes, Daniel T., The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Elzayat, Rami, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Canney, Mark, University of Ottawa, Ottawa, Ontario, Canada
- Djurdjev, Ognjenka, Provincial Health Services Authority, Vancouver, British Columbia, Canada
- Zheng, Yuyan, Provincial Health Services Authority, Vancouver, British Columbia, Canada
- Silver, Samuel A., Queen's University, Kingston, Ontario, Canada
- Levin, Adeera, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
Background
Acute kidney injury (AKI) affects up to 20% of hospitalizations and is associated with increased chronic kidney disease, mortality, and healthcare costs. Proper documentation of AKI in discharge summaries is critical for optimal monitoring and treatment of these patients once discharged. This study aimed to evaluate the accuracy and quality of documentation of episodes of AKI at a tertiary care centre, in British Columbia, Canada.
Methods
This was a retrospective chart review study of adult patients who experienced AKI during hospital admission between January 1, 2018, and December 31, 2018. Laboratory data was used to identify all admissions complicated by AKI defined by KDIGO criteria. A random sample of 300 AKI admissions stratified by AKI severity (e.g., stage, 1, 2, and 3) were identified for chart review. Discharge summaries were reviewed for documentation of the following: presence of AKI, severity of AKI, AKI status at discharge, practitioner and laboratory follow up plans, and medication changes.
Results
Of the 300 discharge summaries reviewed, 38 were excluded. AKI was documented in 140 (53%) of discharge summaries and was more likely to be documented in more severe AKI: stage-1 38%; stage-2 51%; stage-3 75%. Of those with their AKI documented, 94 (67%) documented AKI severity and 116 (83%) mentioned the AKI status at discharge. 239 (91%) of discharge summaries mentioned a follow up plan with a practitioner, but only 23 (10%) had documented nephrology follow up. For laboratory investigations, 92 (35%) of summaries had documented recommendations. In summaries that included medications typically held during AKI, only about half made specific reference to those medications. For those with NSAIDS listed, 64% mentioned holding, and 9% mentioned a discharge plan. For those with ACEi/ARB, 38% mentioned holding these medications, and 46% mentioned a discharge plan. In ones with diuretics listed, 35% mentioned holding, and 51% included a discharge plan.
Conclusion
We found suboptimal quality and completeness of discharge reporting in patients hospitalized with AKI. This may contribute to inadequate follow up and post hospitalization care for this patient population. Strategies are required for increasing the presence and quality of AKI reporting in discharge summaries.