SP247IMPROVING UNDERSTANDING AND RECOGNITION OF ACUTE KIDNEY INJURY AMONGST PATIENTS ON THE ACUTE MEDICAL TAKE

Abstract

Introduction and Aims: Acute Kidney Injury (AKI), defined as a sudden decrease in kidney function, is a common and treatable medical condition, affecting one in six hospital inpatients, leading to death in around one in four of these. Recognition is key to improving the quality of AKI care amongst hospital inpatients. We tested whether focused teaching and prompt‐card distribution improved AKI recognition amongst acute medical inpatients at a large London Teaching Hospital. Methods: All admissions to the acute medical unit (AMU) between 21/4/2014‐4/5/2014 were audited. AKI stages 1‐3 was identified by comparing peak creatinine during admission with baseline. Discharge summaries from the admission were assessed for coding of AKI. Subsequently, teaching was arranged, supported by AKI prompt‐card distribution amongst junior staff. Understanding of AKI was assessed pre‐ and post‐intervention by a questionnaire. Re‐audit was undertaken between 28/7/2014‐4/8/ 2014. Results: Of 400 admissions assessed (50% male), 89 (22.3%) had AKI stages 1‐3 during admission (stage 1 47%, stage 2 40.4%, stage 3 23.5%). AKI patients were older (75 versus 72 years), had a greater length of stay (6 versus 2 days) and highermortality (20.2% versus 2.9%) compared with patients without AKI. Of 89 AKI patients, 80% (71/89) had a completed discharge summary, of which only 45% (32/71) had AKI identified. Questionnaires administered before and after teaching and prompt‐card distribution demonstrated a significant improvement in understanding of AKI identification and management following the intervention (p<0.001). Of 222 admissions assessed on re‐audit (47.7% male), 52 (22.5%) had AKI stages 1‐3. Of these 52 patients, 87% (45/52) had a completed discharge summary, and 82% (37/45) had AKI identified, demonstrating a significant improvement in AKI identification (p<0.001) following implementation of focused teaching and prompt‐card distribution. Furthermore, it was shown that a further 37,085 could have been generated from all AKI cases identified in the complete audit cycle through improved AKI coding accuracy alone. Conclusions: Focused teaching, supported by distribution of AKI prompt‐cards leads to improved understanding and recognition of AKI on the Acute Medical Take, and may also lead to improvements in other parameters for good AKI care. Furthermore, through improved AKI coding, these measures can lead to improved income generation for the Trust, which could be redistributed directly to help improve AKI patient care.