National Acute Kidney Injury (AKI) Project
Acute Kidney Injury (AKI) is a syndrome characterised by an abrupt loss of renal function. AKI is considered a major global health issue and is associated with poor patient outcomes and prolonged lengths of hospital stay. In 2009, a report by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) identified significant deficiencies in the management of AKI in UK hospitals. In response to this and based on a presumption that early identification of AKI may help raise standards of care and improve patient outcomes, an automated real time electronic alerting system for AKI has been established and implemented nationally across all areas of the National Health Service (NHS) in Wales.
The research is carried out by the Welsh AKI Steering Group and is sponsored by the Welsh Renal Clinical Network and Welsh Government. As well as providing support to local AKI quality improvement initiatives carried out across NHS Wales, the project uses the NHS Wales electronic alerting system for AKI as a centralised method of data collection to describe the incidence and outcomes of patients with AKI in Wales. Another aim of the research is to evaluate the effectiveness of using an electronic alert system to improve the quality of care and outcomes for patients with AKI in Wales.
Some of the main findings of the research so far include incidence of AKI in Wales is higher than previously thought, there is a significantly high rate of mortality associated with it, there are differences between hospital and community acquired AKI . Our studies have also highlighted deficiencies in care and shown AKI to be related to social deprivation; specifically we have found that AKI incidence is higher in more socially deprived areas and outcomes are worse for patients with AKI in more socially deprived areas.
Ongoing work includes looking at the longer term impact of an index AKI episode in terms of patient outcomes and recurrent episodes of AKI, using the data to understand more about AKI in a paediatric population, as well as assessing whether early detection of AKI by way of an electronic alerting system actually improves the quality of care and outcomes for patients with AKI.
The research has thus far formed the basis of 9 peer reviewed publications and has helped inform the development of a reporting tool which can be used to monitor and measure AKI related performance across all of NHS Wales. Specifically the tool can be used to monitor trends in AKI incidence and outcomes, identify deficiencies in care received by patients with AKI in Wales, and guide the development of appropriate AKI care intervention strategies undertaken across the service. The information generated by the tool can also be used by healthcare policymakers in Wales when making decisions related to AKI.