Post-discharge care following acute kidney injury: quality improvement in primary care

Howard, Susan J.; Elvey, Rebecca; Ohrnberger, Julius; Turner, Alexander; Anselmi, Laura; Martindale, Anne‐Marie; Blakeman, Tom

doi:10.1136/bmjoq-2019-000891

Cited by 6 publications

(4 citation statements)

References 35 publications

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“…Therefore, we determined discharge summary quality by ascertaining the presence of key elements based on prior published work and our clinical experience. 14 - 16 , 18 , 23 - 26 Overall, there were 9 key elements of AKI included ( Table 1 ) that focus on either a description of the AKI event or follow-up and management recommendations. We calculated a composite score to act as a summary measure of overall discharge summary quality, with each element included assigned 1 point for a maximum possible score of 9 points.…”

Section: Methodsmentioning

confidence: 99%

“… 12 , 13 In patients with AKI, coding of AKI by PCPs following hospital discharge has also been associated with timely medication review, serum creatinine (Cr) monitoring, and patient education. 14 Therefore, higher quality discharge summaries and initiatives to improve communication from the inpatient to outpatient setting have the potential to improve outcomes in the vulnerable post-AKI population. However, few studies have investigated the quality of discharge summaries in patients who survive AKI, which have been limited by small sample size, exclusion of non-critically ill patients, or assessment of few discharge summary elements.…”

Section: Introductionmentioning

confidence: 99%

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The Quality of Discharge Summaries After Acute Kidney Injury

Giles,

Novakovic,

Hopman

et al. 2023

Can J Kidney Health Dis

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Background: Acute kidney injury (AKI) increases the risk of hospital readmission, chronic kidney disease, and death. Therefore, effective communication in discharge summaries is essential for safe transitions of care. Objective: The objectives of this study were to determine the quality of discharge summaries in AKI survivors and identify predictors of higher quality discharge summaries. Design: Retrospective chart review. Setting: Tertiary care academic center in Ontario, Canada. Patients: We examined the discharge summary quality of 300 randomly selected adult patients who survived a hospitalization with AKI at our tertiary care hospital, stratified by AKI severity. We included 150 patients each from 2015 to 2016 and 2018 to 2019, before and after introduction of a post-AKI clinic in 2017. Measurements: We reviewed charts for 9 elements of AKI care to create a composite score summarizing discharge summary quality. Methods: We used multivariable logistic regression to identify predictors of discharge summary quality. Results: The median discharge summary composite score was 4/9 (interquartile range, 2-6). The least frequently mentioned elements were baseline creatinine (n = 55, 18%), AKI-specific follow-up labs (n = 66, 22%), and medication recommendations (n = 80, 27%). The odds of having a higher quality discharge summary (composite score ≥4/9) was greater for every increase in baseline creatinine of 25 μmol/L (adjusted odds ratio [aOR]: 1.27; 95% confidence interval [CI]: 1.03, 1.56), intrarenal etiology (aOR: 2.32; 95% CI: 1.26, 4.27), and increased AKI severity (stage 2 aOR: 2.57; 95% CI: 1.35, 4.91 and stage 3 aOR: 3.36; 95% CI: 1.56, 7.22). There was no association between discharge summary quality and the years before and after introduction of a post-AKI clinic (aOR: 0.77; 95% CI: 0.46, 1.29). Limitations: The single-center study design limits generalizability. Conclusions: Most discharge summaries are missing key AKI elements, even in patients with severe AKI. These gaps suggest several opportunities exist to improve discharge summary communication following AKI.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Quality of Discharge Summaries After Acute Kidney Injury

Giles,

Novakovic,

Hopman

et al. 2023

Can J Kidney Health Dis

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“…Patient attrition during the 3 months follow-up would be considered in the sample pool estimation; however, comprehensive discharge planning and a home follow-up protocol (calls, text messages and home visits, as appropriate) will be implemented to improve patients’ care transitions and reduce attrition rates 37 38…”

Section: Methods and Analysismentioning

confidence: 99%

Development and validation of a clinical prediction model of acute kidney injury in intensive care unit patients at a rural tertiary teaching hospital in South Africa: a study protocol

et al. 2022

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IntroductionAcute kidney injury (AKI) is a decline in renal function lasting hours to days. The rising global incidence of AKI, and associated costs of renal replacement therapy, is a public health priority. With the only therapeutic option being supportive therapy, prevention and early diagnosis will facilitate timely interventions to prevent progression to chronic kidney disease. While many factors have been identified as predictive of AKI, none have shown adequate sensitivity or specificity on their own. Many tools have been developed in developed-country cohorts with higher rates of non-communicable disease, and few have been validated and practically implemented. The development and validation of a predictive tool incorporating clinical, biochemical and imaging parameters, as well as quantification of their impact on the development of AKI, should make timely and improved prediction of AKI possible. This study is positioned to develop and validate an AKI prediction tool in critically ill patients at a rural tertiary hospital in South Africa.Method and analysisCritically ill patients will be followed from admission until discharge or death. Risk factors for AKI will be identified and their impact quantified using statistical modelling. Internal validation of the developed model will be done on separate patients admitted at a different time. Furthermore, patients developing AKI will be monitored for 3 months to assess renal recovery and quality of life. The study will also explore the utility of endothelial monitoring using the biomarker Syndecan-1 and capillary leak measurements in predicting persistent AKI.Ethics and disseminationThe study has been approved by the Walter Sisulu University Faculty of Health Science Research Ethics and Biosafety Committee (WSU No. 005/2021), and the Eastern Cape Department of Health Research Ethics (approval number: EC 202103006). The findings will be shared with facility management, and presented at relevant conferences and seminars.

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“…14,19,31,32 To date, research on AKI education for clinicians has been limited to a few quality improvement studies. 33,34 AKI education for clinicians needs to tailor materials and mode of instruction to the level of training, experience, and subspecialty. Thus, AKI education for clinicians will be an important area of research for the AKI scientific community.…”

Section: Determining Gaps Inmentioning

confidence: 99%

Optimum Care of AKI Survivors Not Requiring Dialysis after Discharge: An AKINow Recovery Workgroup Report

Barreto,

Cerda,

Freshly

et al. 2023

Kidney360

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Acute kidney injury (AKI) affects one in five hospitalized patients and is associated with poor short- and long-term clinical and patient-centered outcomes. Among those who survive to discharge, significant gaps in documentation, education, communication, and follow-up have been observed. The American Society of Nephrology established the AKINow taskforce to address these gaps and improve AKI care. The AKINow Recovery workgroup convened two focus groups, one each focused on dialysis-independent and dialysis-requiring AKI, to summarize the key considerations, challenges, and opportunities in the care of AKI survivors. This manuscript highlights the discussion surrounding care of AKI survivors discharged without the need for dialysis. On May 3, 2022, 48 patients and multidisciplinary clinicians from diverse settings were gathered virtually. The agenda included a patient testimonial, plenary sessions, facilitated small group discussions and debriefing. Core challenges and opportunities for AKI care identified were in the domains of transitions of care, education, collaborative care delivery, diagnostic and therapeutic interventions, and digital health applications. Integrated multispecialty care delivery was identified as one of the greatest challenges to AKI survivor care. Adequate templates for communication and documentation, education of patients, care partners, and clinicians about AKI, and a well-coordinated multidisciplinary post-hospital follow-up plan form the basis for a successful care transition at hospital discharge. The AKINow Recovery workgroup concluded that advancements in evidence-based, patient-centered care of AKI survivors are needed to improve health outcomes, care quality, and patient and provider experience. Tools are being developed by the AKINow Recovery workgroup for use at the hospital discharge to facilitate care continuity.

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Post-discharge care following acute kidney injury: quality improvement in primary care

Cited by 6 publications

References 35 publications

The Quality of Discharge Summaries After Acute Kidney Injury

The Quality of Discharge Summaries After Acute Kidney Injury

Development and validation of a clinical prediction model of acute kidney injury in intensive care unit patients at a rural tertiary teaching hospital in South Africa: a study protocol

Optimum Care of AKI Survivors Not Requiring Dialysis after Discharge: An AKINow Recovery Workgroup Report

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