What did we do?
This project aimed to implement and evaluate novel interventions to manage patients who have had an episode of care complicated by Acute Kidney Injury (AKI).
Our key strategic objectives included:
To implement measures to improve the management of post-AKI care in the primary care setting;
To understand the process of implementation;
To measure the impact of the improvement work;
To provide a platform for potential larger scale evaluation, by building on the currently limited evidence base;
To inform the design of a sustainable model of care to support better medicine management in primary care.
Why was it important?
AKI is a syndrome which is common, harmful and costly. One in five emergency hospital admissions are associated with AKI, and it also increases the frequency, intensity and duration of hospitalisation.
Furthermore, AKI is associated with significantly worse short and long-term outcomes including; higher risk of a further episode of AKI; increased risk of chronic kidney disease (including end stage renal disease); higher mortality rates both in the immediate and longer term. This project focused on improving the management of post-AKI patients in general practice, to lessen the risk of recurrence.
How did we do it?
Undertaken three annual audits of coding and follow-up management of patients who were discharged from hospital with AKI, and fed the results back to the GP practices and the CCG
Supported GP practices via educational events to help them develop action plans for the management of patients with AKI
Qualitatively evaluated the process of implementing AKI alerts in primary care, exploring barriers and enablers to change
- Quantitatively investigated patient outcome measures.
Key Audit Summary Points
- The audit data demonstrated significant improvements in all four criteria measured (Read coding, medication review, kidney function tests and written information given to patients), which was supported statistically. The audit noted improved annotation of information on discharge summaries over the course of the study period; with greater diagnosis, medication information and blood result details
- Despite the improvements in primary care processes associated with the Bury intervention there was no detectable effect on hospital and mortality outcomes on average in the two years following the start of the Bury intervention in April 2016. Intervention effects may emerge in the longer-term
- The educational events were generally well received by all types of participant. The project highlighted the need for multidisciplinary working to manage patients with AKI. For pharmacists in particular, there were opportunities to expand their contribution in primary care; however, various challenges to doing this were also experienced.
Who did we work with?
- Evaluation Reports
Howard S, Elvey R, Ohrnberger J, Turner A, Anelsmi L, Martindale A-M & Blakeman T., 2020. Post-discharge care following acute kidney injury: quality improvement in primary care. BMJ Open Quality
AKI Poster - Blakeman T, Howard S, Corgié D, Grayson S, Ashton Z, Elvey R, Martindale AM, Anselmi L, McCaul F, Tiltstone J