Dr. James Ritchie on behalf of the AKI Care team Improving care and physician education

1. Improving care and
physician education
Dr. James Ritchie
on behalf of the
AKI Care team

2. What is AKI?
“It is a clinical syndrome
characterised by a rapid
reduction in renal
excretory function due to
several different causes…”

3. Background
In the UK, there are more deaths associated
with AKI then VTE and MRSA combined
In the UK, there are more deaths associated
with AKI then VTE and MRSA combined
Data derived from: Hospital Episode Statistics Annual Report 2010,
DoH VTE Prevention Programme 2010 and Selby et al 2012
p<0.0001 p=0.28

4. NCEPOD 2009
• Poor assessment of risk factors
• Unacceptable delay in recognition of post-
admission in AKI in 43%
• 22 patients died with a primary diagnosis of
post-admission AKI which was predictable and
avoidable
• Complications missed (13%), avoidable (17%)
or badly managed (22%)

5. Themes
Risk factor
assessment
Recognition
of AKI
Treatment of
complications

6. Existing platforms

7. Clinical journey
AKI
assessment
Initial
management
Assessment
for
complications
Criteria for
renal referral
Suitability for
inter-hospital
transfer

8. • AKI calculator
• Grades AKI 1-3
• If no AKI, prompts a risk factor
assessment
• Highlights AKI related emergencies
• Provides treatment advice
• Biochemical; potassium / acid-base
• Clinical; pulmonary oedema
• Uraemic; rub / confusion / flap
The AKI Care app

9. Renal referral
• If NICE criteria for referral to renal
services are identified, prompts
for referral to renal services
• Safety checks first to ensure
patient does not first need
discussion with local ICU
• Geolocates appropriate local
centre

10. Summary document

11. Users
• 1/3 junior doctors
• 1/3 consultants
• 1/4 other clinicians
• Specialist nurses

12. Events
• 62% AKI 1
• 15% AKI 3
Consistent with
projected
proportions

13. AKI Complications
• Hyperkalaemia
– Greater than 6.0 mmol/L in 42%
– Greater than 6.5 mmol/L in 30%
Complication Assessed in: Found in:
Confusion 42% 87%
Pericardial rub 25% 82%
Metabolic flap 32% 85%
Pulmonary oedema 32% 87%

14. Treatment
• Treatment advice
used in 60% of
cases
– 1/3 interact with
every stage
– 90% urine dipstick
BloodsFluids
Urine
dip USS
MedsCatheter

15. Iteration
• Identification of test /
real patients
– Record of experience
– Drive use beyond
personal education
• In local SCN, integrate
directly with NORSE
– Allow for direct referral
– Promote real-world
usage