Background Acute Kidney Injury (AKI) is a spectrum of disease that describes a sudden deterioration in renal function. National Patient Safety Data reveals that patients are suffering harm and even dying, due to a delay in its detection. While a perfect biomarker for detecting AKI does not exist, an acute rise in serum creatinine (SCr) underpins most of the published AKI definitions. In 2014 NHS England, in partnership with the UK Renal Registry, developed a National AKI Prevention Programme: ‘Think Kidneys’ comprising an AKI Warning Algorithm and Best Practice Guideline. A key recommendation in this document involved the use of an E-alert system based on SCr results to notify clinicians of potential cases of AKI.
Aim We aimed to evaluate our local E-alert system during the first 10 weeks of its implementation, assess the validity of alerted results and identify clinician responses to all AKI 2/3 alerts.
Method The laboratory identified every AKI alert in the time frame. We collected demographic and location data on all these alerts using ICE desktop and detailed information on the management of all clinically significant AKI 1, AKI 2 and 3 through notes review.
Results 134 AKI alerts were generated in the time frame (AKI 1=127, AKI 2=6, AKI 3=1), the highest incidence being in the Haematology/Oncology population (38%). We demonstrated that 70% of AKI 1 alerts were generated from a median SCr result baseline over the previous 8–365 days (rather than a recent result). In 0% of these cases was there any progression of the AKI. Key shortfalls in the clinical management in response to a significant AKI alert included lack of attention to fluid management and nephrotoxic medication.
Conclusion As a result of our findings AKI 1 results generated from a median baseline over 8–365 days are no longer deemed necessary to phone through, saving precious laboratory and clinical time. Perhaps more importantly, in those with definite AKI which was clinically significant and progressive we have recommended a change in laboratory practice. Local AKI education is required to optimise the clinical response.
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