Service evaluation of the implementation of a digitally-enabled care pathway for the recognition and management of acute kidney injury

Abstract

Acute Kidney Injury (AKI), an abrupt deterioration in kidney function, is defined by changes in urine output or serum creatinine. AKI is common (affecting up to 20% of acute hospital admissions in the United Kingdom), associated with significant morbidity and mortality, and expensive (excess costs to the National Health Service in England alone may exceed £1 billion per year). NHS England has mandated the implementation of an automated algorithm to detect AKI based on changes in serum creatinine, and to alert clinicians. It is uncertain, however, whether ‘alerting’ alone improves care quality. We have thus developed a digitally-enabled care pathway as a clinical service to inpatients in the Royal Free Hospital (RFH), a large London hospital. This pathway incorporates a mobile software application - the “Streams-AKI” app, developed by DeepMind Health - that applies the NHS AKI algorithm to routinely collected serum creatinine data in hospital inpatients. Streams-AKI alerts clinicians to potential AKI cases, furnishing them with a trend view of kidney function alongside other relevant data, in real-time, on a mobile device. A clinical response team comprising nephrologists and critical care nurses responds to these AKI alerts by reviewing individual patients and administering interventions according to existing clinical practice guidelines. We propose a mixed methods service evaluation of the implementation of this care pathway. This evaluation will assess how the care pathway meets the health and care needs of service users (RFH inpatients), in terms of clinical outcome, processes of care, and NHS costs. It will also seek to assess acceptance of the pathway by members of the response team and wider hospital community. All analyses will be undertaken by the service evaluation team from UCL (Department of Applied Health Research) and St George’s, University of London (Population Health Research Institute).

Acute kidney injury is associated with increased healthcare utilization, complications, and mortality after primary total knee arthroplasty

“…Implementation of an AKI care pathway triggered by an abnormal serum-creatinine value is an example of an intervention that may reduce AKI-associated morbidity and improve outcomes by early diagnosis and treatment. 21 Our study findings must be interpreted considering limitations. NIS counts discharges, not people, that is, data are not at patient level.…”

“…Implementation of an AKI care pathway triggered by an abnormal serum-creatinine value is an example of an intervention that may reduce AKI-associated morbidity and improve outcomes by early diagnosis and treatment. 21…”

Impact of Daily Electronic Laboratory Alerting on Early Detection and Clinical Documentation of Acute Kidney Injury in Hospital Settings

“…3,13 Second, alert fatigue is avoided by consolidating daily alerts into a single report for morning rounds. 18,25,26 Third, there is an educational focus on provider behavioral change in conjunction with implementing the daily AKI alerts. 9,27,28 Fourth, clinical documentation compliance is promoted by partnering with CDI professionals.…”

Evaluation of a digitally-enabled care pathway for acute kidney injury management in hospital emergency admissions

“…The study design protocol has been previously published. 29 The impact of the optimised care pathway on clinical outcomes was assessed by comparing data from the deployment phase (May to September 2017) to data from a pre-deployment phase (May 2016 to January 2017) in both the intervention and comparator sites. The primary outcome was recovery of renal function, defined as a return to a creatinine level within 120% of the baseline (itself defined by NHSEDA) prior to hospital discharge.…”