Identifying acute kidney injury in the community--a novel informatics approach.

BACKGROUND: Acute kidney injury (AKI) is a serious and common problem that is associated with high mortality. Currently nearly all efforts at improving outcomes in AKI have been focused on secondary care. We now know that a large number of patients most likely develop the condition in primary care. To our knowledge there has been no previous attempts to approach this topic from the primary care perspective. AIM: To test the utility of novel informatics software to identify patients with AKI in the community. SETTING AND METHOD: We carried out a retrospective audit of patients in one urban practice in Leicestershire using novel informatics software. The audit data was run on two occasions, once for high-risk patients between 4th July 2010 through until 30th September 2013, and once for low risk patients for the period of 27th October 2011 through until 21st January 2014. RESULTS: During the period of the data collection the average practice list size was 12,420, with 235 and 19 AKI episodes in the high and low risk groups respectively. The annual AKI incidence was 27.9/1000 in the high-risk group, 1.22/1000 in the low risk group, and 10.6/1000 overall. The most common associated factor was sepsis in 170 patients, followed by dehydration in 54 patients. CONCLUSION: We have shown it is possible to identify patients with AKI in the community using informatics software. Our data suggests that AKI in the community is much more common than previously thought and demonstrates the need to better understand this condition from the primary care perspective.

Is the post-take ward round standardised?

BACKGROUND: The importance of the post-take ward round to both patient safety and medical education cannot be overemphasised. Despite this, significant variation exists between consultants and senior doctors in the conduct and content of ward rounds. This discrepancy prompted the idea of using a checklist to audit whether essential components were being consistently addressed during post-take ward rounds. This would allow an exploration of whether introducing a checklist would benefit both patient safety and medical education. METHODS: The post-take ward round was audited by a small group of medical students over a few months using a checklist. This checklist contained 17 evidence-based items that had been identified as important for patient safety. A number of different consultants were included in the audit. RESULTS: Results of the audit analysis confirmed that there was significant variability between consultants in both the approach and the content of the post-take ward round. Although some areas were completed most of the time, there were other areas in which inconsistent approaches were demonstrated. DISCUSSION: As such variability was demonstrated between consultants in their conduct of the ward rounds, it was concluded that the introduction of this checklist would provide a standardised approach that junior doctors could learn from. Therefore, the introduction of this checklist into clinical practice was identified as a worthwhile teaching resource for juniors in order to enhance patient safety and foundation doctor learning.