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

BMJ Open Quality

article

Susan J Howard¹  Rebecca Elvey¹  Julius Ohrnberger⁴  Alex J Turner⁵  Laura Anselmi⁵  Anne-Marie Martindale¹  Tom Blakeman¹ 

[1] NIHR Applied Research Collaboration Greater Manchester ,(ARC-GM) , Health Innovation Manchester;Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care;School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK , The University of Manchester;Department of Infectious Disease Epidemiology , Imperial College London;Health Organisation, Policy and Economics ,(HOPE) group, Centre for Primary Care and Health Services Research , The University of Manchester

关键词: acute kidney injury;    patient safety;    primary care;    audit and feedback;    clinical audit;   

DOI  :  10.1136/bmjoq-2019-000891

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Background Over the past decade, targeting acute kidney injury (AKI) has become a priority to improve patient safety and health outcomes. Illness complicated by AKI is common and is associated with adverse outcomes including high rates of unplanned hospital readmission. Through national patient safety directives, NHS England has mandated the implementation of an AKI clinical decision support system in hospitals. In order to improve care following AKI, hospitals have also been incentivised to improve discharge summaries and general practices are recommended to establish registers of people who have had an episode of illness complicated by AKI. However, to date, there is limited evidence surrounding the development and impact of interventions following AKI.Design We conducted a quality improvement project in primary care aiming to improve the management of patients following an episode of hospital care complicated by AKI. All 31 general practices within a single NHS Clinical Commissioning Group were incentivised by a locally commissioned service to engage in audit and feedback, education training and to develop an action plan at each practice to improve management of AKI.Results AKI coding in general practice increased from 28% of cases in 2015/2016 to 50% in 2017/2018. Coding of AKI was associated with significant improvements in downstream patient management in terms of conducting a medication review within 1 month of hospital discharge, monitoring kidney function within 3 months and providing written information about AKI to patients. However, there was no effect on unplanned hospitalisation and mortality.Conclusion The findings suggest that the quality improvement intervention successfully engaged a primary care workforce in AKI-related care, but that a higher intensity intervention is likely to be required to improve health outcomes. Development of a real-time audit tool is necessary to better understand and minimise the impact of the high mortality rate following AKI.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND