P11
ACUTE KIDNEY INJURY: DOES THE PTWR CONTRIBUTE TO THE DIAGNOSIS?
Authors: Dr B. Carter, Dr SNT Murphy; Dept of Medicine Princess Royal Hospital,
Haywards Heath
Aim: Prompt recognition of acute kidney injury (AKI) leads to better outcomes.1 NCEPOD has
shown that the national standard of care is sub-optimal.2 KDIGO recommendations3 in AKI
management include a consultant review within 12 hours of admission; this audit looked at the
impact of this review on the frequency of diagnosis.
Method: A six week audit of all acute medical admissions was performed. Winpath blood
results were used to identify patients with AKI using KDIGO criteria. The notes were reviewed
to assess the frequency with which the diagnosis of AKI was documented at key milestones in
the patient’s hospital journey.
Results: 50 patients were identified in whom notes were available for 38. During initial clerking
by junior doctors, 16 patients (42.1%) had no documentation of AKI. All patients were
reviewed by a consultant within 12 hours. AKI was specifically mentioned on the PTWR in 20
cases (52.6%) and when combining junior doctor clerking and consultant ward round
documentation, there were still 9 patients (23.7%) who had no documentation of AKI. 73.7% of
cases had U&Es repeated within 24 hours, 52.6% had a urine dipstick performed. 5 patients
died (13.2%); of 31 discharge summaries available, 9 (29.0%) had no mention of AKI.
Conclusion: The consultant ward round increased the recognition of AKI by a further 18.4%
but many still went unrecognised, this translated to poor management plans. The only long-term
viable solution involves additional headings in the admission proforma or the use of electronic
patient records with automatic alerts linked through from pathology. These would aim to draw
attention to renal impairment and encourage proper documentation of AKI. The deficiencies in
management plans may indicate a lack of awareness and need to formally educate physicians on
the gold standard of AKI patient management.
References:
1. Ali, T.; Khan, I.; Simpson, W.; Prescott, G.; Townend, J.; Smith, W. & MacLeod, A.
Incidence and Outcomes in Acute Kidney Injury: A Comprehensive Population-Based
Study. JASN Apr 1, 2007 18: 1292-1298
2. Adding insult to injury. A review of the care of patients who died in hospital with a
primary diagnosis of acute kidney injury (acute renal failure). A report by the National
Confidential Enquiry into Patient Outcome and Death (2009) www.NCEPOD.org.uk
3. KDIGO (Kidney Disease, Improving Global Outcomes). Kidney International Supp.
Mar 2012; 2 (1): 8-12